Skip to main content

Advertisement

SpringerLink
Log in

Clinical Efficacy of Transjugular Intrahepatic Portosystemic Shunt Created with Expanded Polytetrafluoroethylene-Covered Stent-Grafts: 8-mm Versus 10-mm

  • Clinical Investigation
  • TIPS
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

Conflicting data exist regarding the appropriate shunt diameter for transjugular intrahepatic portosystemic shunt (TIPS) creation in cirrhotic patients. This study was designed to compare the clinical efficacy of TIPS using stent-grafts with 8- and 10-mm diameters.

Methods

In this retrospective study, cirrhotic patients who underwent TIPS technical successfully for the prevention of variceal rebleeding from December 2011 to June 2015 were included. Thirty-four patients with 8-mm TIPS and 380 patients with 10-mm TIPS were identified. Propensity score matching method produced 32 patients in each group for comparison.

Results

Baseline characteristics between two groups were comparable. There was no significant difference in variceal rebleeding rate between the two groups. The cumulative incidence of variceal rebleeding after 1 and 3 years was 6.4% and 35.5% in the 8-mm group, respectively, and 14.2% and 24.9% in the 10-mm group, respectively (P = 0.663). 8-mm TIPS conferred a significant decrease in hepatic encephalopathy (HE) rate compared with the 10-mm TIPS (16.1 vs. 32.6% at 1 year, 27.8 vs. 53.2% at 3 years, P = 0.034). The cumulative survival rates were similar between the two groups: 93.3% and 79.6% at 1 and 3 years, respectively, in the 8-mm TIPS group vs. 87.3% and 72.1% at 1 and 3 years, respectively, in the 10-mm TIPS group (P = 0.451).

Conclusion

The placement of 8-mm TIPS was sufficient to decompress the portal hypertension and prevent variceal rebleeding. The use of the 8-mm stent-graft can decrease HE rates compared with 10-mm stent-graft, although no survival benefit was observed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

TIPS:

Transjugular intrahepatic portosystemic shunt

PSG:

Portosystemic gradient

HE:

Hepatic encephalopathy

ePTFE:

Expanded polytetrafluoroethylene

SD:

Standard deviation

PSM:

Propensity score matching

MELD:

Model for end-stage liver disease

PVT:

Portal vein thrombosis

PT:

Prothrombin time

INR:

International normalized ratio

TB:

Total bilirubin

HCC:

Hepatocellular carcinoma

References

  1. Parker R. Role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension. Clin Liver Dis. 2014;18(2):319–34.

    Article  PubMed  Google Scholar 

  2. Rossle M. TIPS: 25 years later. J Hepatol. 2013;59(5):1081–93.

    Article  PubMed  Google Scholar 

  3. Boyer TD, Haskal ZJ. The role of transjugular intrahepatic portosystemic shunt (TIPS) in the management of portal hypertension: update 2009. Hepatology. 2010;51(1):306.

    Article  PubMed  Google Scholar 

  4. Haskal ZJ, Martin L, Cardella JF, et al. Quality improvement guidelines for transjugular intrahepatic portosystemic shunts. J Vasc Interv Radiol. 2003;14(9 Pt 2):S265–70.

    PubMed  Google Scholar 

  5. Riggio O, Ridola L, Angeloni S, et al. Clinical efficacy of transjugular intrahepatic portosystemic shunt created with covered stents with different diameters: results of a randomized controlled trial. J Hepatol. 2010;53(2):267–72.

    Article  PubMed  Google Scholar 

  6. Luo X, Wang Z, Tsauo J, Zhou B, Zhang H, Li X. Advanced cirrhosis combined with portal vein thrombosis: a randomized trial of TIPS versus endoscopic band ligation plus propranolol for the prevention of recurrent esophageal variceal bleeding. Radiology. 2015;276(1):286–93.

    Article  PubMed  Google Scholar 

  7. de Franchis R. Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol. 2010;53(4):762–8.

    Article  PubMed  Google Scholar 

  8. Conn HO, Leevy CM, Vlahcevic ZR, et al. Comparison of lactulose and neomycin in the treatment of chronic portal-systemic encephalopathy: a double blind controlled trial. Gastroenterology. 1977;72(4 Pt 1):573–83.

    PubMed  CAS  Google Scholar 

  9. Siegerstetter V, Krause T, Rossle M, et al. Transjugular intrahepatic portosystemic shunt (TIPS) thrombogenicity in stents and its effect on shunt patency. Acta Radiol. 1997;38(4 Pt 1):558–64.

    PubMed  CAS  Google Scholar 

  10. Krajina A, Hulek P, Fejfar T, Valek V. Quality improvement guidelines for transjugular intrahepatic portosystemic shunt (TIPS). Cardiovasc Interv Radiol. 2012;35(6):1295–300.

    Article  Google Scholar 

  11. Sauerbruch T, Mengel M, Dollinger M, et al. Prevention of rebleeding from esophageal varices in patients with cirrhosis receiving small-diameter stents versus hemodynamically controlled medical therapy. Gastroenterology. 2015;149(3):660–8.

    Article  PubMed  Google Scholar 

  12. Holster IL, Tjwa ET, Moelker A, et al. Covered TIPS vs endoscopic therapy + beta-blocker for prevention of variceal rebleeding. Hepatology. 2015;63(2):581–9.

    Article  PubMed  CAS  Google Scholar 

  13. Sanyal AJ, Freedman AM, Shiffman ML, Purdum PP III, Luketic VA, Cheatham AK. Portosystemic encephalopathy after transjugular intrahepatic portosystemic shunt: results of a prospective controlled study. Hepatology. 1994;20(1 Pt 1):46–55.

    PubMed  CAS  Google Scholar 

  14. Somberg KA, Riegler JL, LaBerge JM, et al. Hepatic encephalopathy after transjugular intrahepatic portosystemic shunts: incidence and risk factors. Am J Gastroenterol. 1995;90(4):549–55.

    PubMed  CAS  Google Scholar 

  15. Bai M, Qi X, Yang Z, et al. Predictors of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in cirrhotic patients: a systematic review. J Gastroenterol Hepatol. 2011;26(6):943–51.

    Article  PubMed  Google Scholar 

  16. Riggio O, Angeloni S, Salvatori FM, et al. Incidence, natural history, and risk factors of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt with polytetrafluoroethylene-covered stent grafts. Am J Gastroenterol. 2008;103(11):2738–46.

    Article  PubMed  Google Scholar 

  17. Rossle M, Gerbes AL. TIPS for the treatment of refractory ascites, hepatorenal syndrome and hepatic hydrothorax: a critical update. Gut. 2010;59(7):988–1000.

    Article  PubMed  Google Scholar 

  18. Gaba RC, Parvinian A, Minocha J, et al. Should transjugular intrahepatic portosystemic shunt stent grafts be underdilated? J Vasc Interv Radiol. 2015;26(3):382–7.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, People’s Republic of China

    Xuefeng Luo, Xiaoze Wang, Yongjun Zhu, Xiaotan Xi, Ying Zhao, Jinlin Yang & Li Yang

  2. Department of Interventional Radiology, National Cancer Center and Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100021, China

    Xiao Li

Authors
  1. Xuefeng Luo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xiaoze Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yongjun Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xiaotan Xi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ying Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jinlin Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Xiao Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Li Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Li Yang.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Luo, X., Wang, X., Zhu, Y. et al. Clinical Efficacy of Transjugular Intrahepatic Portosystemic Shunt Created with Expanded Polytetrafluoroethylene-Covered Stent-Grafts: 8-mm Versus 10-mm. Cardiovasc Intervent Radiol 42, 737–743 (2019). https://doi.org/10.1007/s00270-019-02162-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-019-02162-4

Keywords

Search

Navigation