WALLSTENT™ Endoprosthesis - Boston Scientific- US

A. Direct portogram showed occluded initial stent and numerous collaterals veins. B. After PS creation with second Wallgraft endoprosthesis, portogram showed good flow through shunt, without opacification of collateral veins. C. PS dysfunction developed 13 months later, and third PS was created with Wallgraft endoprosthesis. D. Final portogram showed widely patent shunt. TIPS = transjugular intrahepatic portosystemic shunt, PS = parallel shunt


Wallgraft endoprosthesis in the brachiocephalic trunk with exclusion of the pseudoaneurysm.
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The Strecker™ Stent (Boston Scientific Corp.; Natick, Mass). The Strecker stent is made of a tubular wire mesh knitted from a single electropolished tantalum filament. It has a premounted balloon, and it has good radiopacity. The flexibility of this stent is a valuable feature. It is available in diameters from 4 to 12 mm with lengths of 20, 40, 60, and 80 mm.

BOSTON SCIENTIFIC Wallgraft Endoprosthesis - 70-545 …

The procedure was explained in detail to all patients, and written consent was obtained from each patient before the procedure. All procedures were performed or supervised by one experienced interventional radiologist. PS was created using the classic TIPS technique (). In our series, the portal vein was punctured from the middle or right hepatic vein in 16 patients and from the inferior vena cava (IVC) in 2 patients. Once the catheter position in the portal vein was confirmed, a 5 Fr pigtail catheter (Cordis, Roden, the Netherlands) was introduced into the portal region, and a portography was obtained to outline the portal venous anatomy. Then, the liver parenchymal tract was dilated with an 8 × 60 mm angioplasty balloon (Cordis, Roden, the Netherlands). The stent-graft was deployed to cover the entire length of the shunt to the junction of the hepatic vein and IVC. In the first 10 patients, a 10-mm-diameter Wallgraft endoprosthesis (Boston Scientific, Galway, Ireland) was used. In the latter 8 patients, an 8-mm-diameter Fluency endoprosthesis (Bard, Karlsruhe, Germany) was used. After this, a final shunt venogram was performed. In addition, the portosystemic pressure gradient (PPG) was measured before and after the procedure. Patients with a PPG higher than 12 mm Hg underwent prophylactic embolization of varices with metal coils.

The premounted Wallgraft Endoprosthesis is available on a Unistep Plus delivery system (Figure 1).
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using both the Wallgraft endoprosthesis (Boston Scientific ..

Reports of experience with many types of stents at the iliac level are available. Vorwerk and coworkers treated 109 patients with 118 lesions who had iliac artery stenoses (mean length, 3 ± 2 cm) with 142 Wallstent endoprostheses after insufficient balloon angioplasty. At 4 years, the PI was 82% and the PII was 91%. A multicenter study of 486 patients given Palmaz stents revealed a technical success rate of 99% and a 2-year clinical patency of 84%. Strecker and co-authors reported a 3-year patency rate of 95% in patients with the tantalum Strecker stent positioned in the iliac arteries. Our experience with Palmaz stents at the iliac level included 184 patients (230 stents). The technical success rate was 99.7%. The 4-year PI was 86% and the PII was 94%. The patency rates were similar or slightly improved by the use of a shape-memory nitinol prosthesis. In treating 155 iliac lesions (130 stenoses and 25 occlusions), the PI was 89.7% and the PII was 98.7% at 4 years.

Wallgraft (Boston Scientific, ..

The post-endovascular procedure tomography showed thrombosis of the pseudoaneurysm and appropriate spread of the endoprosthesis, with size reduction of the mediastinal hematoma (Figure 2B).

1-Year Patency Rates for Endoprosthesis Cited in the Literature

In addition, various experimental and clinical studies have verified the application of ePTFE-covered stent-grafts in de novo TIPS creation and TIPS revision (). The ePTFE is utilized as a cover material for the stent-grafts, separating the blood flow within the shunt from the liver parenchyma and from the injured outflow hepatic vein. After the creation of TIPS with an ePTFE-covered stent-graft, the shunt flow is maintained by inhibiting the overgrowth of the pseudointimal hyperplasia in the parenchymal tract or along the outflow hepatic vein. Park JS also found that the intraluminal irradiation with Holmium-166 for the TIPS significantly improved the TIPS patency in a swine model (). In the present study, a PS creation with the ePTFE-covered stent-grafts was performed in the latter nine patients. The differences between the Wallgraft endoprostheses and the Fluency endoprostheses did not reach statistical significance due to the small number of patients enrolled, but our data do show a tendency favoring the ePTFE-covered stent grafts.