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European Radiology

, Volume 14, Issue 10, pp 1842–1850 | Cite as

Early and long-term clinical and radiological follow-up results of expanded-polytetrafluoroethylene-covered stent-grafts for transjugular intrahepatic portosystemic shunt procedures

  • Geert MaleuxEmail author
  • Frederik Nevens
  • Alexander Wilmer
  • Sam Heye
  • Chris Verslype
  • Maria Thijs
  • Guy Wilms
Vascular-Interventional

Abstract

The purpose of this study was to assess the therapeutic efficacy and immediate and long-term safety of expanded-tetrafluoroethylene covered stent-grafts for transjugular intrahepatic portosystemic shunts in patients with portal hypertension-related complications. A cohort of 56 patients suffering from severe portal hypertension-related complications underwent implantation of an expanded-polytetrafluoroethylene-covered stent-graft. All patients suffered from severe liver cirrhosis graded Child-Pugh A (n=8; 16%), B (n=13; 21%) or C (n=35; 63%). In 44 patients, the stent-graft was placed during the initial TIPS procedure (de novo TIPS); in the other 12 patients, the stent-graft was placed to repermeabilize the previously placed bare stent (TIPS revision). Follow-up was performed with clinical assessment, duplex ultrasound and, if abnormal or inconclusive, with invasive venography and pressure measurements. Per- en immediate post-procedural complications occurred in four patients (4/56, 7%). None of them was lethal. During follow-up, stent occlusion appeared in one patient and stenosis in two; no recurrence of bleeding was noted in all patients treated for variceal bleeding (n=28), and 24 of the 28 patients (86%) suffering from refractory ascites and/or hepatic hydrothorax were free of regular paracenteses and/or drainage of pleural effusion after shunt creation. The 30-day and global mortality for the total study population (n=56) was, respectively, 7% (n=4) and 28.5% (n=16). In the patient subgroup with variceal bleeding (n=28), 30-day mortality was 3.5% (n=1) and global mortality 14.2% (n=4). In the ascites and/or hydrothorax subgroup (n=28), 8.1% (n=3) mortality at 30 days was found and global mortality was 32.4% (n=12). In 10 patients of the 56 studied patients (18%), isolated hepatic encephalopathy occurred, which was lethal in 4 (Child C) patients (7%). Three of these four patients died within the 1st month after TIPS placement. A very high primary patency rate of TIPS can be obtained long-term after implantation of an e-PTFE-covered stent-graft, leading to a definitive resolution of portal hypertension-related complications. The incidence of TIPS-induced hepatic encephalopathy is acceptable.

Keywords

Liver Interventional procedures Hypertension Portal Shunts Portosystemic Stents and prostheses 

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Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Geert Maleux
    • 1
    Email author
  • Frederik Nevens
    • 2
  • Alexander Wilmer
    • 3
  • Sam Heye
    • 1
  • Chris Verslype
    • 2
  • Maria Thijs
    • 1
  • Guy Wilms
    • 1
  1. 1.Department of RadiologyUniversity Hospitals GasthuisbergLeuvenBelgium
  2. 2.Department of HepatologyUniversity Hospitals GasthuisbergLeuvenBelgium
  3. 3.Department of Medical Intensive Care UnitUniversity Hospitals GasthuisbergLeuvenBelgium

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