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

  • Xuefeng Luo
  • Xiaoze Wang
  • Yongjun Zhu
  • Xiaotan Xi
  • Ying Zhao
  • Jinlin Yang
  • Xiao Li
  • Li YangEmail author
Clinical Investigation TIPS
  • 51 Downloads
Part of the following topical collections:
  1. TIPS

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.

Keywords

Transjugular intrahepatic portosystemic shunt Expanded polytetrafluoroethylene-covered 8-mm stent-grafts Variceal bleeding 

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

Notes

Compliance with Ethical Standards

Conflict of interest

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

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2019

Authors and Affiliations

  1. 1.Department of Gastroenterology and Hepatology, West China HospitalSichuan UniversityChengduPeople’s Republic of China
  2. 2.Department of Interventional Radiology, National Cancer Center and Cancer HospitalChinese Academy of Medical Science and Peking Union Medical CollegeBeijingChina

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