Published online Feb 27, 2019. doi: 10.4254/wjh.v11.i2.217
Peer-review started: August 31, 2018
First decision: October 16, 2018
Revised: December 31, 2018
Accepted: January 9, 2019
Article in press: January 9, 2019
Published online: February 27, 2019
Transjugular intrahepatic portosystemic shunts (TIPS) can alleviate complications of portal hypertension such as ascites and variceal bleeding by decreasing the portosystemic gradient. In limited clinical situations, parallel TIPS may be only solution to alleviate either variceal bleeding or ascites secondary to portal hypertension when the primary TIPS fails to do so. Data specifically addressing the use of this partially polytetrafluoroethylene covered nitinol stent (Viatorr®) is largely lacking despite Viatorr® being the current gold standard for modern TIPS placement.
All three patients had portal hypertension and already had a primary Viatorr® TIPS placed previously. All patients have undergone failed endoscopy to manage acute variceal bleeding before referral for a parallel stent (PS). PS were placed in patients presenting with recurrent variceal bleeding despite existence of a widely patent primary TIPS. Primary stent patency was verified with either Doppler ultrasound or intra-procedural TIPS stent venography. Doppler ultrasound follow-up imaging demonstrated complete patency of both primary and parallel TIPS. All three patients did well on clinical follow-up of up to six months and no major complications were recorded. A review of existing literature on the role of PS in the management of portal hypertension complications is discussed. There are three case reports of use of primary and PS Viatorr® stents placement, only one of which is in a patient with gastrointestinal variceal bleeding despite a patent primary Viatorr® TIPS.
Viatorr® PS placement in the management of variceal hemorrhage is feasible with promising short term patency and clinical follow-up data.
Core tip: To our knowledge, we are first to report a three-case series with 6-month follow-up data using Viatorr® for both primary transjugular intrahepatic portosystemic shunt (TIPS) and parallel TIPS placement for the management of recurrent upper gastrointestinal variceal hemorrhage. Although, parallel TIPS placement has been previously reported, it was largely using bare metal stents and/or fully covered stents. Data regarding the use of the partially polytetrafluoroethylene-covered nitinol stent (Viatorr®) in parallel TIPS placement is largely lacking despite this device being the current gold standard for TIPS placement.