Clinical Efficacy of Transjugular Intrahepatic Portosystemic Shunt Created with Expanded Polytetrafluoroethylene-Covered Stent-Grafts: 8-mm Versus 10-mm
- 51 Downloads
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.
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.
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).
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.
KeywordsTransjugular intrahepatic portosystemic shunt Expanded polytetrafluoroethylene-covered 8-mm stent-grafts Variceal bleeding
Transjugular intrahepatic portosystemic shunt
Propensity score matching
Model for end-stage liver disease
Portal vein thrombosis
International normalized ratio
Compliance with Ethical Standards
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
- 1.Parker R. Role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension. Clin Liver Dis. 2014;18(2):319–34.Google Scholar
- 2.Rossle M. TIPS: 25 years later. J Hepatol. 2013;59(5):1081–93.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.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.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.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.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.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.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.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.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.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.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.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.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.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.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.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.Google Scholar