IVUSガイド下Direct Intrahepatic Portosystemic Shunt(DIPS)とTIPS専用stent graft


IVUSガイド下Direct Intrahepatic Portosystemic Shunt(DIPS)とTIPS専用stent graft

Transjugular Intrahepatic Portosystemic Shunt (TIPS) 専用stent graft (Viatorr® Gore) は、操作上の簡便性及びbare stentと比した良好な一次開存率から欧米ではTIPSに欠く事の出来ないdeviceとされているが、未だ本邦には導入されていない。又、TIPS自体がその侵襲性と手技の難易度の高さ、胃静脈瘤の別の治療法であるBRTOの普及・発展から、本邦では標準治療としての認知を得ていない。今回、TIPSの最大の弱点である侵襲性を血管内超音波ガイドで補うDirect Intrahepatic Portocaval Shunt (DIPS)の手技を紹介するとともに、TIPS専用stent graftの意義を問い直す機会としたい。

The dedicated Transjugular Intrahepatic Portosystemic Shunt (TIPS) stent graft (Viatorr, WL Gore & Associates) is an effective device with superior patency to bare metal stents; however, it is still unavailable in Japan. The TIPS procedure itself has not been widely accepted by most Japanese physicians because of the inherent invasiveness of the procedure and preferred treatment option of Balloon Occluded Retrograde Obliteration for gastric varices. We introduce a safe and feasible method to create a portosystemic shunt under intravascular ultrasound (IVUS) guidance: Direct Intrahepatic Portocaval Shunt (DIPS). The combination of IVUS guided DIPS and Viatorr graft provides an alternative treatment option for Japanese physicians.