Skip to main content
SpringerLink
Log in

Added Value of Covered Stents in Transjugular Intrahepatic Portosystemic Shunt: A Large Single-Center Experience

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

Abstract

Purpose

Transjugular intrahepatic portosystemic shunts (TIPS) were historically placed using uncovered bare-metal stents. Current practice has now shifted toward the use of polytetrafluoroethylene (PTFE)-covered stents, given the improved primary patency seen with these stents. The aim of this study was to determine whether there is any added value, such as overall survival or stent patency, when using covered stents versus uncovered stents in TIPS placement in a large cohort.

Materials and Methods

From April 1995 to June 2012, a total of 744 consecutive adult patients underwent de novo TIPS placement (378 receiving uncovered stents, 366 receiving covered stents). Information was obtained on demographics, baseline clinical variables, and outcomes after TIPS placement. Data were collected, compared, and analyzed to assess outcomes including mortality, primary patency (determined via repeat intervention), and secondary patency (determined via ultrasound parameters).

Results

Covered stents were associated with significantly improved primary patency (P < 0.001) and secondary patency (P < 0.001) when compared with uncovered stents in TIPS procedures. Additionally, covered stents were associated with higher estimated overall survival rates and higher survival rates when TIPS was performed emergently and in patients with higher Model for End-Stage Liver Disease (MELD) scores. For example, in patients with MELD scores between 11 and 18, there was a predicted survival of 59.2% with covered stents versus 42.8% with uncovered stents at 1 year.

Conclusion

This study demonstrated that covered stents offer the additional value of higher estimated overall survival and higher estimated survival in patients undergoing TIPS emergently and in those with higher MELD scores when compared to uncovered stents.

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
Fig. 4

Similar content being viewed by others

References

  1. Nazarian GK, Ferral H, Castañeda-Zúñiga WR, Bjarnason H, Foshager MC, Rank JM, et al. Development of stenoses in transjugular intrahepatic portosystemic shunts. Radiology. 1994;192(1):231–4.

    Article  CAS  PubMed  Google Scholar 

  2. LaBerge JM, Ferrell LD, Ring EJ, Gordon RL. Histopathologic study of stenotic and occluded transjugular intrahepatic portosystemic shunts. J Vasc Interv Radiol. 1993;4(6):779–86.

    Article  CAS  PubMed  Google Scholar 

  3. Thalheimer U, Leandro G, Samonakis DN, Triantos CK, Senzolo M, Fung K, et al. TIPS for refractory ascites: a single-centre experience. J Gastroenterol. 2009;44(10):1089–95.

    Article  PubMed  Google Scholar 

  4. Riggio O, Ridola L, Angeloni S, Cerini F, Pasquale C, Attili AF, 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 

  5. Lauermann J, Potthoff A, Mc Cavert M, Marquardt S, Vaske B, Rosenthal H, et al. Comparison of technical and clinical outcome of transjugular portosystemic shunt placement between a bare metal stent and a PTFE-stentgraft device. Cardiovasc Interv Radiol. 2016;39(4):547–56.

    Article  CAS  Google Scholar 

  6. Heinzow HS, Lenz P, Köhler M, et al. Clinical outcome and predictors of survival after TIPS insertion in patients with liver cirrhosis. World J Gastroenterol. 2012;18(37):5211–8.

    PubMed  PubMed Central  Google Scholar 

  7. Dariushnia SR, Haskal ZJ, Midia M, Martin LG, Walker TG, Kalva SP, et al. Society of interventional radiology standards of practice committee. Quality improvement guidelines for transjugular intrahepatic portosystemic shunts. J Vasc Interv Radiol. 2016;27(1):1–7.

    Article  PubMed  Google Scholar 

  8. Luca A, Miraglia R, Maruzzelli L, D’amico M, Tuzzolino F. Early liver failure after transjugular intrahepatic portosystemic shunt in patients with cirrhosis with model for end-stage liver disease score of 12 or less: incidence, outcome, and prognostic factors. Radiology. 2016;280(2):622–9.

    Article  PubMed  Google Scholar 

  9. Bureau C, Thabut D, Oberti F, Dharancy S, Carbonell N, Bouvier A, et al. Transjugular intrahepatic portosystemic shunts with covered stents increase transplant-free survival of patients with cirrhosis and recurrent ascites. Gastroenterology. 2017;152(1):157–63.

    Article  PubMed  Google Scholar 

  10. Angermayr B, Cejna M, Koenig F, Karnel F, Hackl F, Gangl A, et al. Survival in patients undergoing transjugular intrahepatic portosystemic shunt: ePTFE-covered stentgrafts versus bare stents. Hepatology. 2003;38(4):1043–50.

    Article  PubMed  Google Scholar 

  11. Barrio J, Ripoll C, Bañares R, Echenagusia A, Catalina MV, Camúñez F, et al. Comparison of transjugular intrahepatic portosystemic shunt dysfunction in PTFE-covered stent-grafts versus bare stents. Eur J Radiol. 2005;55(1):120–4.

    Article  PubMed  Google Scholar 

  12. Tripathi D, Ferguson J, Barkell H, Macbeth K, Ireland H, Redhead DN, et al. Improved clinical outcome with transjugular intrahepatic portosystemic stent-shunt utilizing polytetrafluoroethylene-covered stents. Eur J Gastroenterol Hepatol. 2006;18(3):225–32.

    Article  CAS  PubMed  Google Scholar 

  13. Sommer CM, Gockner TL, Stampfl U, Bellemann N, Sauer P, Ganten T, et al. Technical and clinical outcome of transjugular intrahepatic portosystemic stent shunt: bare metal stents (BMS) versus viatorr stent-grafts (VSG). Eur J Radiol. 2012;81(9):2273–80.

    Article  PubMed  Google Scholar 

  14. Bureau C, Garcia-Pagan JC, Otal P, Pomier-Layrargues G, Chabbert V, Cortez C, et al. Improved clinical outcome using polytetrafluoroethylene-coated stents for TIPS: results of a randomized study. Gastroenterology. 2004;126(2):469–75.

    Article  PubMed  Google Scholar 

  15. Bureau C, Pagan JC, Layrargues GP, Metivier S, Bellot P, Perreault P, et al. Patency of stents covered with polytetrafluoroethylene in patients treated by transjugular intrahepatic portosystemic shunts: long-term results of a randomized multicentre study. Liver Int. 2007;27(6):742–7.

    Article  CAS  PubMed  Google Scholar 

  16. Yang Z, Han G, Wu Q, Ye X, Jin Z, Yin Z, et al. Patency and clinical outcomes of transjugular intrahepatic portosystemic shunt with polytetrafluoroethylene-covered stents versus bare stents: a meta-analysis. J Gastroenterol Hepatol. 2010;25(11):1718–25.

    Article  PubMed  Google Scholar 

  17. Perarnau JM, Le Gouge A, Nicolas C, d’Alteroche L, Borentain P, Saliba F, et al. STIC-TIPS group. Covered vs. uncovered stents for transjugular intrahepatic portosystemic shunt: a randomized controlled trial. J Hepatol. 2014;60(5):962–8.

    Article  PubMed  Google Scholar 

  18. Angeloni S, Merli M, Salvatori FM, De Santis A, Fanelli F, Pepino D, et al. Polytetrafluoroethylene-covered stent grafts for TIPS procedure: 1-year patency and clinical results. Am J Gastroenterol. 2004;99(2):280–5.

    Article  PubMed  Google Scholar 

  19. Hernández-Guerra M, Turnes J, Rubinstein P, Olliff S, Elias E, Bosch J, et al. PTFE-covered stents improve TIPS patency in Budd-Chiari syndrome. Hepatology. 2004;40(5):1197–202.

    Article  PubMed  Google Scholar 

  20. Jung HS, Kalva SP, Greenfield AJ, Waltman AC, Walker TG, Athanasoulis CA, et al. TIPS: comparison of shunt patency and clinical outcomes between bare stents and expanded polytetrafluoroethylene stent-grafts. J Vasc Interv Radiol. 2009;20(2):180–5.

    Article  PubMed  Google Scholar 

  21. Gaba RC, Omene BO, Podczerwinski ES, Knuttinen MG, Cotler SJ, Kallwitz ER, et al. TIPS for treatment of variceal hemorrhage: clinical outcomes in 128 patients at a single institution over a 12-year period. J Vasc Interv Radiol. 2012;23(2):227–35.

    Article  PubMed  Google Scholar 

  22. Clark W, Golkar F, Luberice K, Toomey P, Paul H, Marcadis A, et al. Uncovering the truth about covered stents: is there a difference between covered versus uncovered stents with transjugular intrahepatic portosystemic shunts? Am J Surg. 2011;202(5):561–4.

    Article  PubMed  Google Scholar 

  23. Bandi JC, Solari J, Rostagno R, Galdame O, Garcia-Monaco R, Gadano AC. Long term follow up of patients treated with coated stents TIPS. J Hepatol. 2010;52(Suppl 1):S328.

    Article  Google Scholar 

  24. Maleux G, Perez-Gutierrez NA, Evrard S, Mroue A, Le Moine O, Laleman W, et al. 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. 2010;73(3):336–41.

    CAS  PubMed  Google Scholar 

  25. Carbonell N, Pauwels A, Serfaty L, Fourdan O, Lévy VG, Poupon R. Improved survival after variceal bleeding in patients with cirrhosis over the past two decades. Hepatology. 2004;40(3):652–9.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to acknowledge Megan Griffiths, Scientific/Medical Writer at Cleveland Clinic, for her contributions in editing this work.

Author information

Authors and Affiliations

  1. Department of Vascular and Interventional Radiology, Cleveland Clinic, Cleveland, OH, USA

    Amar C. Gupta, Mark J. Sands, Pilar M. Bayona & Baljendra Kapoor

  2. Department of Radiology, Mayo Clinic, Jacksonville, FL, USA

    Weiping Wang

  3. Department of Diagnostic Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Chintan Shah

  4. Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA

    Jennifer Bullen

  5. Department of Abdominal Imaging, Cleveland Clinic, Cleveland, OH, USA

    Erick M. Remer

  6. Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA

    William Carey

Authors
  1. Amar C. Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Weiping Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chintan Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mark J. Sands
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jennifer Bullen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Erick M. Remer
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Pilar M. Bayona
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. William Carey
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Baljendra Kapoor
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Amar C. Gupta.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Human and Animal Rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

This is a retrospective study. For this type of study, formal consent is not required.

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 32 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gupta, A.C., Wang, W., Shah, C. et al. Added Value of Covered Stents in Transjugular Intrahepatic Portosystemic Shunt: A Large Single-Center Experience. Cardiovasc Intervent Radiol 40, 1723–1731 (2017). https://doi.org/10.1007/s00270-017-1694-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-017-1694-1

Keywords

Search

Navigation