Skip to main content

Advertisement

SpringerLink
Log in

Impact of PTFE-covered stent position and extension on TIPS patency

  • Interventional Radiology
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

The objectives of this study were to determine the effects of expanded polytetrafluoroethylene (PTFE)-covered stent location and TIPS extension on primary patency.

Methods

This retrospective cohort study examined patients with PTFE-covered TIPS creation between 07/2002 and 06/2016. Clinical information and patency outcomes at 24 months were extracted. At TIPS creation, extension was performed at the discretion of the operator. Kaplan–Meier curves of primary patency were generated with conditional variables of HVO-HCJ distance, extension status, and covered versus uncovered extensions. Additional logistic regression analyses of distances were performed.

Results

Of 393 patients, 115 patients (29%) underwent stent extension, 79 (20% of total cohort) of which were at the HVO end alone. Primary patency for all TIPS was 75%, 68%, and 54% at 3, 6, and 12 months. The data endpoint were transplant or death in 92 (23%) and 116 (30%). Kaplan–Meier curves showed no statistically significant difference between the variables and primary patency at 12 and 24 months: distance up to versus greater than 10 mm (p = 0.32, 0.81); extension versus no extension (p = 0.83, 0.85); uncovered versus covered extensions (p = 0.58, 0.70). Logistic regression analyses showed a trend toward statistical significance.

Conclusion

In the setting of PTFE-covered TIPS creation, extended TIPSs and unextended well-positioned TIPSs have no difference in primary patency rates. Stent position and extension length may have an effect on primary patency, but were likely obscured by “user recognition” effects.

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

Similar content being viewed by others

Data availability

All data generated or analyzed during this study are not publicly available due to identifiable patient information but are available in the departmental quality assurance database.

References

  1. Boyer TD, Haskal ZJ, American Association for the Study of Liver D. The Role of Transjugular Intrahepatic Portosystemic Shunt (TIPS) in the Management of Portal Hypertension: update 2009. Hepatology 2010;51:306. https://doi.org/10.1002/hep.23383.

  2. Qi X, Han G, He C, Yin Z, Zhang H, Wang J, et al. Transjugular intrahepatic portosystemic shunt may be superior to conservative therapy for variceal rebleeding in cirrhotic patients with non-tumoral portal vein thrombosis: a hypothesis. Med Sci Monit 2012;18:HY37–41.

  3. Barrio J, Ripoll C, Banares R, Echenagusia A, Catalina M V, Camunez F, et al. Comparison of transjugular intrahepatic portosystemic shunt dysfunction in PTFE-covered stent-grafts versus bare stents. Eur J Radiol 2005;55:120–4. https://doi.org/10.1016/j.ejrad.2004.10.007.

    Article  PubMed  Google Scholar 

  4. Weber CN, Nadolski GJ, White SB, Clark TW, Mondschein JI, Stavropoulos SW, et al. Long-Term Patency and Clinical Analysis of Expanded Polytetrafluoroethylene-Covered Transjugular Intrahepatic Portosystemic Shunt Stent Grafts. J Vasc Interv Radiol 2015;26:1257–65; quiz 1265. https://doi.org/10.1016/j.jvir.2015.04.005.

  5. Clark TW, Agarwal R, Haskal ZJ, Stavropoulos SW. The effect of initial shunt outflow position on patency of transjugular intrahepatic portosystemic shunts. J Vasc Interv Radiol 2004;15:147–52.

    Article  Google Scholar 

  6. Bai M, He CY, Qi XS, Yin ZX, Wang JH, Guo WG, et al. Shunting branch of portal vein and stent position predict survival after transjugular intrahepatic portosystemic shunt. World J Gastroenterol 2014;20:774–85. https://doi.org/10.3748/wjg.v20.i3.774.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Luo SH, Chu JG, Huang H, Yao KC. Effect of initial stent position on patency of transjugular intrahepatic portosystemic shunt. World J Gastroenterol 2017;23:4779–87. https://doi.org/10.3748/wjg.v23.i26.4779.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Clark TW. Stepwise placement of a transjugular intrahepatic portosystemic shunt endograft. Tech Vasc Interv Radiol 2008;11:208–11. https://doi.org/10.1053/j.tvir.2009.04.002.

    Article  PubMed  Google Scholar 

  9. Andring B, Kalva SP, Sutphin P, Srinivasa R, Anene A, Burrell M, et al. Effect of technical parameters on transjugular intrahepatic portosystemic shunts utilizing stent grafts. World J Gastroenterol 2015;21:8110–7. https://doi.org/10.3748/wjg.v21.i26.8110.

    Article  PubMed  PubMed Central  Google Scholar 

  10. LaBerge JM, Somberg KA, Lake JR, Gordon RL, Kerlan Jr. RK, Ascher NL, et al. Two-year outcome following transjugular intrahepatic portosystemic shunt for variceal bleeding: results in 90 patients. Gastroenterology 1995;108:1143–51.

    Article  CAS  Google Scholar 

  11. Sze DY, Vestring T, Liddell RP, Kato N, Semba CP, Razavi MK, et al. Recurrent TIPS failure associated with biliary fistulae: treatment with PTFE-covered stents. Cardiovasc Interv Radiol 1999;22:298–304.

    Article  CAS  Google Scholar 

  12. Ducoin H, El-Khoury J, Rousseau H, Barange K, Peron JM, Pierragi MT, et al. Histopathologic analysis of transjugular intrahepatic portosystemic shunts. Hepatology 1997;25:1064–9. https://doi.org/10.1002/hep.510250503.

    Article  CAS  PubMed  Google Scholar 

  13. Huang Q, Wu X, Fan X, Cao J, Han J, Xu L, et al. Comparison study of Doppler ultrasound surveillance of expanded polytetrafluoroethylene-covered stent versus bare stent in transjugular intrahepatic portosystemic shunt. J Clin Ultrasound 2010;38:353–60. https://doi.org/10.1002/jcu.20709.

    Article  PubMed  Google Scholar 

  14. Marin ML, Veith FJ, Cynamon J, Parsons RE, Lyon RT, Suggs WD, et al. Effect of polytetrafluoroethylene covering of Palmaz stents on the development of intimal hyperplasia in human iliac arteries. J Vasc Interv Radiol 1996;7:651–6.

    Article  CAS  Google Scholar 

  15. Klasen-Sansone J, Bode J, Lanzman RS, Kubitz R, Immig S, Heusch P, et al. TIPS geometry influences patency. Z Gastroenterol 2015;53:28–32. https://doi.org/10.1055/s-0034-1385430.

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

This study was not supported by any funding.

Author information

Authors and Affiliations

  1. Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street 1 Silverstein, Philadelphia, PA, 19104, USA

    Joshua K. Cho

  2. Perelman School of Medicine - University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Juan Serna, Mandeep Dagli, Jeffrey I. Mondschein, Richard D. Shlansky-Goldberg, Scott O. Trerotola, Michael C. Soulen, S. William Stavropoulos & Gregory J. Nadolski

  3. Penn Presbyterian Medical Center, 51 N 39th St 4 Wright-Saunders, Philadelphia, PA, 19104, USA

    Timothy W. I. Clark

Authors
  1. Joshua K. Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Juan Serna
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Timothy W. I. Clark
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mandeep Dagli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jeffrey I. Mondschein
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Richard D. Shlansky-Goldberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Scott O. Trerotola
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Michael C. Soulen
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. S. William Stavropoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Gregory J. Nadolski
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joshua K. Cho.

Ethics declarations

Conflict of interest

Joshua K. Cho, MD: None, Juan Serna: None, Timothy W. I. Clark, MD: Consultant—Teleflex, Becton Dickinson, B. Braun; Royalties—Teleflex, Merit, Mandeep Dagli, MD: None, Jeffrey I. Mondschein, MD: None, Richard D. Shlansky-Goldberg, MD: None, Scott O. Trerotola, MD: Consultant—WL Gore, Cook, MedComp, Teleflex, BD Bard, Adrenas; Royalty—Cook, Teleflex, Michael C. Soulen, MD: Research grant—Guerbet LLC, BTG International, Sirtex Medical; Consultant—Guerbet LLC, Genentech, S. William Stavropoulos, MD: Research grant—Sillajen, Cook; Consultant—Becton Dickinson, Gregory J. Nadolski, MD: None.

Ethical approval

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

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cho, J.K., Serna, J., Clark, T.W.I. et al. Impact of PTFE-covered stent position and extension on TIPS patency. Abdom Radiol 45, 3915–3922 (2020). https://doi.org/10.1007/s00261-020-02566-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-020-02566-8

Keywords

Search

Navigation