Adjustable diameter TIPS in the pediatric patient: the constrained technique

Özet

Placement of transjugular intrahepatic portosystemic shunt (TIPS) is necessary in children withportal hypertension complicated by variceal bleeding or ascites. However, placement of adultsizedendografts may be problematic due to the smaller anatomy of pediatric patients. On theother hand, placement of fixed diameter smaller stents have the corresponding problem of notaccommodating future growth of the child. We describe a novel method to create an adjustablediameter TIPS as a technical solution to these problems. In this technique, a balloon expandablebare metal stent is placed concentrically around the ePTFE TIPS endograft, creating an intentional narrowing in the shunt diameter than can be expanded with balloon dilation at future proceduresas needed. This allows for optimal calibration of shunt hemodynamics according to thechild’s growth and prevents the potential need for placement of additional shunts or technicallychallenging TIPS reduction procedures.