Midterm Follow-up of Transjugular Intrahepatic Portosystemic Shunts Using Polytetrafluoroethylene Endografts in Children

Purpose: To report the initial experience of a pediatric center's use of expanded polytetrafluoroethylene (ePTFE) endografts for the creation of transjugular intrahepatic portosystemic shunts (TIPSs) in children. Materials and Methods: Twelve consecutive patients had a TIPS created, all with ePTFE endografts. Nine were children younger than 18 years of age: one infant (age 18 mo) and eight adolescent children with a median age of 14 years, 3 months (range, 10 y, 1 mo, to 17 y, 2 mo). All had gastric or esophageal varices. Acute variceal bleeding was the primary indication in four of nine cases (44%). Mean follow-up was 20 months (range, 4 d to 32 mo). Results: Technical success rate was 100%. Seven TIPSs (78%) were created with a 10-mm-diameter endograft and two (22%) were created with an 8-mm-diameter endograft. Mean portosystemic gradient was reduced from 15.9 mm Hg to 5.8 mm Hg after TIPS creation. The devices were not dilated to their nominal diameter in seven of nine cases (78%). There were no major complications or mortalities associated with TIPS creation. There was one minor complication during follow-up in which a child developed progressively increasing lethargy. Primary patency rate by ultrasound during follow-up was 100%. There were no shunt dysfunctions or repeat interventions required, and no clinical recurrences. One child received a liver transplant 4 days after TIPS creation. Conclusions: TIPSs can be created in children with the use of ePTFE endografts with an excellent midterm primary patency rate and a low complication rate.