Top

Pediatric Radiology

Published in:

01-03-2015 | Original Article

Safety and efficacy of expanded polytetrafluoroethylene-covered transjugular intrahepatic portosystemic shunts in children with acute or recurring upper gastrointestinal bleeding

Authors: Luis J. Zurera, Juan J. Espejo, Sagrario Lombardo, Juan J. Gilbert, Miguel Canis, Concepción Ruiz

Published in: Pediatric Radiology | Issue 3/2015

Abstract

Background

The transjugular intrahepatic portosystemic shunt (TIPS) is effective for treating complications of portal hypertension in cirrhotic adults but the experience in children is limited.

Objective

To retrospectively review the safety and efficacy of expanded polytetrafluoroethylene (ePTFE)-covered TIPS in children with acute or recurrent gastrointestinal bleeding.

Materials and methods

We reviewed the medical records of children who received implants of 10-mm-diameter PTFE-covered endoprostheses for acute or recurring upper gastrointestinal bleeding caused by medically or endoscopically uncontrollable varices. The recurrence of upper gastrointestinal bleeding, associated complications and permeability were assessed with Doppler sonography sequentially or up to transplantation.

Results

In all children (n = 12; mean age 9 years; mean weight 30 kg) a single endoprosthesis was implanted with no associated mortality. The mean initial transhepatic gradient was 15 mmHg (range 3–21 mmHg), dropping to 7 mmHg (range 1–12 mmHg) after TIPS. Immediate complications were mild encephalopathy (n = 1) and acute occlusion of the TIPS (n = 1). Stenosis of the TIPS was observed in two children, at 9 months and 54 months follow-up, and thrombosis was observed in two children, at 7 months and 12 months follow-up. All four stenoses/occlusions were resolved with coaxial endoprostheses.

Conclusion

The safety profile and efficacy of expanded polytetrafluoroethylene (ePTFE)-covered TIPS were satisfactory in this small series of children with acute or recurrent gastrointestinal bleeding.

Garcia-Pagan JC, Caca K, Bureau C et al (2010) Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med 362:2370–2379CrossRefPubMed

Rossle M, Ochs A, Gulberg V et al (2000) A comparison of paracentesis and transjugular intrahepatic portosystemic shunting in patients with ascites. N Engl J Med 342:1701–1707CrossRefPubMed

Hackworth CA, Leef JA, Rosenblum JD et al (1998) Transjugular intrahepatic portosystemic shunt creation in children: initial clinical experience. Radiology 206:109–114CrossRefPubMed

Lorenz J (2008) Placement of transjugular intrahepatic portosystemic shunts in children. Technol Cardiovasc Intervent Radiol 11:235–240CrossRef

Bureau C, Garcia-Pagan JC, Layrargues GP et al (2007) Patency of stents covered with polytetrafluorethylene in patients treated by transjugular intrahepatic portosystemic shunts: long-term results of a randomised multicentre study. Liver Int 27:742–747CrossRefPubMed

Huppert PE, Goffette P, Astfal W et al (2002) Transjugular intrahepatic portosystemsic shunt in children with biliary atresia. Cardiovasc Intervent Radiol 25:484–493CrossRefPubMed

Vo NJ, Shivariam GM, Andrews RT et al (2012) Midterm follow-up of transjugular intrahepatic portosystemic shunts using polytetrafluoroethylene endografts in children. J Vasc Interv Radiol 23:919–924CrossRefPubMed

Di Giorgio A, Agazzi R, Alberti D et al (2012) Feasibility and efficacy of transjugular intrahepatic porto-systemic shunt (TIPS) in children. J Pediatr Gastroenterol Nutr 54:594–600CrossRefPubMed

Shneider BL, Bosch J, de Franchis R et al (2012) Portal hypertension in children: expert pediatric opinion on the report of the Baveno v Consensus workshop on methodology of diagnosis and therapy in portal hypertension. Pediatr Transplant 16:426–437CrossRefPubMed

10.

Eesa M, Clark T (2011) Transjugular intrahepatic portosystemic shunt: state of the art. Semin Roentgenol 46:125–132CrossRefPubMed

11.

Kalva SP, Salazar GM, Walker G (2009) Transjugular intrahepatic portosystemic shunt of acute variceal hemorrhage. Technol Cardiovasc Intervent Radiol 12:92–101CrossRef

12.

Pozler O, Krajina A, Vanicek H et al (2003) Transjugular intrahepatic portosystemic shunt in five children with cystic fibrosis: long term results. Hepatogastroenterology 50:1111–1114PubMed

13.

Heyman M, LaBerge J, Sombely K et al (1997) Transjugular intrahepatic portosystemic shunt in children. J Pediatr 131:914–919CrossRefPubMed

14.

Mileti E, Rosenthal P (2011) Management of portal hypertension in children. Curr Gastroenterol Rep 13:10–16CrossRefPubMedCentralPubMed

15.

Chlapoutaki CE, Franchi-Abella S, Habes D et al (2009) Custom-made covered transjugular intrahepatic portosytemic shunt (TIPS) in an infant with trisomy 22 and biliary atresia. Pediatr Radiol 39:739–742CrossRefPubMed

16.

Maleux G, Perez-Gutierrez NA, Evrard S et al (2010) Covered stents are better than uncovered stents for transjugular intrahepatic portosystemic shunts in cirrhotic patients with refractory ascites: a retrospective cohort study. Acta Gastroenterol Belg 73:336–341PubMed

17.

Mermuys K, Maleux G, Heye S et al (2008) Use of the Viatorr expanded polytetrafluoroethylene-covered stent-graft for transjugular intrahepatic portosystemic shunt creation in children: initial clinical experience. Cardiovasc Intervent Radiol 31:S192–S196CrossRefPubMed

18.

Van Ha TG, Funaki BS, Ehrhardt J et al (2005) Transjugular intrahepatic portosystemic shunt placement in liver transplant recipients: experiences with pediatric and adult patients. AJR Am J Roentgenol 184:920–925CrossRefPubMed

19.

Rössle M (2013) TIPS: 25 years later. J Hepatol 59:1081–1093CrossRefPubMed

20.

Schweizer P, Brambs HJ, Schweizer M et al (1995) TIPS: a new therapy for esophageal variceal bleeding caused by EHBA. Eur J Pediatr Surg 5:211–215CrossRefPubMed

21.

Miller DL, Balter S, Schueler BA et al (2010) Clinical radiation management for fluoroscopically guided interventional procedures. Radiology 257:321–332CrossRefPubMed

22.

Hernanz-Schulman M, Goske MJ, Bercha IH et al (2011) Pause and pulse: ten steps that help manage radiation dose during pediatric fluoroscopy. AJR Am J Roentgenol 197:475–481CrossRefPubMed

Title: Safety and efficacy of expanded polytetrafluoroethylene-covered transjugular intrahepatic portosystemic shunts in children with acute or recurring upper gastrointestinal bleeding
Authors: Luis J. Zurera
Juan J. Espejo
Sagrario Lombardo
Juan J. Gilbert
Miguel Canis
Concepción Ruiz
Publication date: 01-03-2015
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Radiology / Issue 3/2015
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI: https://doi.org/10.1007/s00247-014-3181-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Safety and efficacy of expanded polytetrafluoroethylene-covered transjugular intrahepatic portosystemic shunts in children with acute or recurring upper gastrointestinal bleeding

Abstract

Background

Objective

Materials and methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Objective

Materials and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2015

Reply to Ozkan et al. regarding ‘Acoustic radiation force impulse elastography for detection of renal damage in children’

Three-dimensional quantitative analysis of the proximal femur and the pelvis in children and adolescents using an upright biplanar slot-scanning X-ray system

Imaging of pediatric pathology during the Iraq and Afghanistan conflicts

Torsion of a giant mesocolic lipoma in a child with Bannayan-Riley-Ruvalcaba syndrome

Frequency of skeletal injuries in children with inflicted burns

Early detection of temporomandibular joint arthritis in children with juvenile idiopathic arthritis – the role of contrast-enhanced MRI