Custom-made covered transjugular intrahepatic portosystemic shunt (TIPS) in an infant with trisomy 22 and biliary atresia.

We report an 8-month-old girl with portal hypertension secondary to biliary atresia. The decision to treat with TIPS was made at the age of 8 months due to recurrent variceal bleeding. The procedure was carried out with a 6-mm bare stent due to her small size. Radiological follow-up with Doppler US showed gradual stenosis and finally occlusion of the stent 80 days after implantation. Revision was performed with placement of an additional 6-mm expanded polytetrafluoroethylene (e-PTFE) stent-graft that had remained patent for 9 months, proving that in small children with a portal vein diameter less than 8 mm, the combination of a bare stent and stent-graft can provide excellent results.

Suprarenal inferior vena cava filters: a 20-year single-center experience.

PURPOSE: To assess the clinical safety and efficacy of suprarenal inferior vena cava (IVC) filters during long-term follow-up. MATERIALS AND METHODS: In this retrospective study, the authors collected the following data about patients who underwent suprarenal IVC filter placement at their institution between 1988 and 2007: demographics, clinical presentation, indications for filter placement, reasons for placing the filter in the suprarenal IVC, type of filter, frequency of pulmonary embolism (PE) after filter placement, and filter-related problems during follow-up. RESULTS: Seventy patients (32 male and 38 female patients; mean age, 60 years) had suprarenal IVC filters. Sixty-two patients presented with symptoms of venous thromboembolism (VTE) and eight had incidental asymptomatic VTE at imaging. Indications for filter placement were as follows: contraindication to anticoagulation (n = 48), complications and/or failure of anticoagulation (n = 12), added protection (n = 8), and prophylaxis (n = 2). Suprarenal placement was chosen due to IVC thrombus (n = 41), intrinsic and/or extrinsic narrowing of the infrarenal IVC (n = 9), renal and/or gonadal vein thrombus (n = 3), congenital IVC anomalies (n = 6), pelvic mass (n = 5), pregnancy (n = 3), and other reasons (n = 3). The following filters were used: Greenfield (n = 29), Simon Nitinol (n = 5), Vena-Tech (n = 3), TrapEase (n = 22), OptEase (n = 3), Tulip (n = 6), Bird's Nest (n = 1), and Recovery (n = 1). During follow-up (mean, 573 days +/- 953), postfilter PE was suspected in 10 patients; eight patients underwent computed tomography (CT), one of whom had PE at CT. None developed new symptoms of caval thrombosis. Abdominal CT (performed in 30 patients at a mean of 543 days +/- 768) showed thrombus in the filter in three patients, fracture in one patient, and penetration of the IVC wall in two patients. CONCLUSIONS: Suprarenal filters are safe and effective in preventing PE. The placement of IVC filters above the renal veins does not carry an added risk of complications.

Clinical experience with Günther temporary inferior vena cava filters.

This retrospective study was performed to evaluate the safety and effectiveness of Günther temporary inferior vena cava (IVC) filters. Fifteen Günther temporary filters were placed in 13 patients because of deep vein thrombosis (DVT) with pulmonary embolism (PE) despite DVT prophylaxis (9/13) or temporary contraindications for anticoagulants as well as recent or pending surgery (4/13). No clinical manifestation of PE was observed during the filtration or during the removal. Günther temporary IVC filters are easy and safe to use, and are effective in clot trapping, protecting patients at high risk for PE in whom anticoagulation treatment failed or is contraindicated.