Abstract
Purpose
To retrospectively analyse long-term patency and overall survival of cirrhotic patients treated with TIPSS using e-PTFE-covered stents. Additionally, prognostic factors for better patency and survival were analysed.
Materials and methods
Two hundred and eighty-five consecutive cirrhotic patients with severe portal hypertension-related symptoms were included. Follow-up, including clinical assessment and duplex ultrasound, was analysed up to end of study, patient’s death, liver transplantation or TIPSS-reduction. Patency rates and overall survival were estimated by the Kaplan-Meier method; potential differences in outcome between subgroups were calculated using the Pepe and Mori test.
Results
The 1-, 2- and 5-year primary patencies were 91.5 %, 89.2 % and 86.2 %, respectively, with no new shunt dysfunctions after 5 years’ follow-up. TIPSS revision was performed more often in ascites patients (P = 0.02). The 1-, 4- and 10-year survival rates were 69.2 %, 52.1 % and 30.7 %, respectively. Survival was higher in Child-Pugh class A-B (P = 0.04), in the recurrent bleeding group (P = 0.008) and in patients with underlying alcoholic cirrhosis (P = 0.01).
Conclusion
Long term, primary patency of e-PTFE-covered TIPSS stents remains very high (>80 %); shunt revision was required more frequently in ascites patients. Overall survival was better in Child-Pugh A-B patients with recurrent variceal bleeding and alcoholic liver cirrhosis.
Keypoints
• Long-term primary patency rate of e-PTFE-covered TIPSS stents remains very high.
• No new shunt dysfunction was found after 5 years of follow-up.
• Shunt revision was required more frequently in ascites patients.
• Four and 10 years’ overall survival was 50 and 30 %, respectively.
Similar content being viewed by others
References
Tripathy D, Helmy A, Macbeth K et al (2004) Ten years’ follow-up of 472 patients following transjugular intrahepatic portosystemic stent-shunt insertion at a single centre. Eur J Gastroenterol Hepatol 16:9–18
Ter Borg P, Hollemans M, Van Buuren H et al (2004) Transjugular intrahepatic portosystemic shunts: long-term patency and clinical results in a patient cohort observed for 3–9 years. Radiology 231:537–545
Riggio O, Ridola L, Angeloni S et al (2010) Clinical efficacy of transjugular intrahepatic portosystemic shunt created with covered stents with different diameters: results of a randomized controlled trial. J Hepatol 53:267–272
Bureau C, Pagan J, Layrargues G et al (2007) Patency of stents covered with polytetrafluoroethylene in patients treated by transjugular intrahepatic portosystemic shunts: long-term results of a randomized multicenter study. Liver Int 27:742–747
Rössle M, Siegerstetter V, Euringer W et al (2006) The use of polytetrafluoroethylene-covered stent graft for transjugular intrahepatic portosystemic shunt (TIPS): Long-term follow-up of 100 patients. Acta Radiol 47:660–666
Vignali C, Bargellini I, Grosso M et al (2005) TIPS with expanded polytetrafluoroethylene-covered stent: results of an Italian multicenter study. Am J Roentgenol 185:472–480
Charon J, Alaeddin F, Pimpalwar S et al (2004) Results of a retrospective multicenter trial of the Viatorr expanded polytetraethylene-covered stent-graft for transjugular intrahepatic portosystemic shunt creation. J Vasc Interv Radiol 15:1219–1230
Maleux G, Nevens F, Wilmer A et al (2004) Early and long-term clinical and radiological follow-up results of expanded-polytetrafluoroethylene-covered stent-grafts for transjugular intrahepatic portosytemic shunt procedures. Eur Radiol 14:1842–1850
Angeloni S, Merli M, Salvatori F et al (2004) Polytetrafluoroethylene-covered stent grafts for TIPS procedure: 1-year patency and clinical results. Am J Gastroenterol 99:280–285
Bureau C, Garcia-Pagan J, Otal P et al (2004) Improved clinical outome using polytetrafluoroethylene-coated stents for TIPS: results of a randomized study. Gastroenterology 126:469–475
Angermayr B, Cejna M, Koenig F et al (2003) Survival in patients undergoing transjugular intrahepatic portosystemic shunt: ePTFE-covered stentgrafts versus bare stents. Hepatology 38:1043–1050
Maleux G, Perez-Gutierrez N, Evrard S et al (2010) Covered stents are better than uncovered stents for transjugular intrahepatic portosystemic shunts in cirrhotic patients with refractory ascites: a retrospective cohort study. Acta Gastroenterol Belg 73:336–341
Rossi P, Salvatori F, Fanelli F et al (2004) Polytetrafluoroethylene-covered nitinol stent-graft for transjugular intrahepatic portosystemic shunt creation: 3-year experience. Radiology 231:820–830
Hausegger K, Karnel F, Georgieva B et al (2004) Transjugular intrahepatic portosystemic shunt creation with the Viatorr expanded polytetrafluoroethylene-covered stent-graft. J Vasc Interv Radiol 15:239–248
Cejna M, Peck-Radosavljevic M, Thurnher S, Hittmair K, Schoder M, Lammer J (2001) Creation of transjugular intrahepatic portosystemic shunts with stent-grafts: initial experiences with polytetrafluoroethylene-covered nitinol endoprosthesis. Radiology 221:437–446
Weber C, Nadolski G, White S et al (2015) Long-term patency and clinical analysis of expanded polytetrafluoroethylene-covered transjugular intrahepatic portosystemic shunt stent grafts. J Vasc Interv Radiol 26:1257–1265, Quiz 1265
Zhuang Z, Teng G, Jeffery R, Gemery J, Janne d’Othee B, Bettmann M (2002) Long-term results and quality of life in patients treated with transjugular intrahepatic shunts. Am J Roentgenol 179:1597–1603
Bercu Z, Fischman A, Kim E et al (2015) TIPS for refractory ascites: a 6-year single-center experience with expanded polytetrafluoroethylene-covered stent-grafts. Am J Roentgenol 204:654–661
Montgomery A, Ferral H, Vasan R, Postoak D (2005) MELD score as a predictor of early death in patients undergoing elective transjugular intrahepatic portosystemic shunt (TIPS) procedures. Cardiovasc Intervent Radiol 28:307–312
Acknowledgments
The scientific guarantor of this publication is Geert Maleux. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. The Interuniversity Institute for Biostatistics and Statistical Bioinformatics, KU Leuven and University of Hasselt, Belgium kindly provided statistical advice for this manuscript. Institutional Review Board approval was obtained.
Written informed consent was not required for this study because it was a retrospective, observational study. Methodology: retrospective, observational, performed at one institution.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Geeroms, B., Laleman, W., Laenen, A. et al. Expanded polytetrafluoroethylene-covered stent-grafts for transjugular intrahepatic portosystemic shunts in cirrhotic patients: Long-term patency and clinical outcome results. Eur Radiol 27, 1795–1803 (2017). https://doi.org/10.1007/s00330-016-4570-5
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-016-4570-5