Patency of stents covered with polytetrafluoroethylene in patients treated by transjugular intrahepatic portosystemic shunts: long‐term results of a randomized multicentre study

Abstract

An 80% dysfunction rate at 2 years limits the use of transjugular intrahepatic portosystemic shunts (TIPS) in the treatment of complications of portal hypertension. The use of covered stents could improve shunt patency; however, long-term effect and safety remain unknown. Eighty patients randomized to be treated by TIPS either with a covered stent (Group 1) or an uncovered prosthesis (Group 2) were followed-up for 2 years. Doppler US was performed every 3 months. Angiography and portosystemic pressure gradient measurement were performed every 6 months or whenever dysfunction was suspected. Actuarial rates of primary patency in Groups 1 and 2 were 76% and 36% respectively (P=0.001). Clinical relapse occurred in four patients (10%) in Group 1 and 12 (29%) in Group 2 (P<0.05). Actuarial rates of being free of encephalopathy were 67% in Group 1 and 51% in Group 2 (P<0.05). Probability of survival was 58% and 45% at 2 years, respectively, in Groups 1 and 2 (NS). The mean Child-Pugh score improved only in Group 1 (from 8.1+/-1.6 to 7+/-2.2 at 2 years -P<0.05). We also compared the Doppler-US parameters between patent and dysfunctioning shunts. In patent shunts, the mean velocity within the portal vein was significantly higher but the performance of Doppler-US was not accurate enough to predict shunt dysfunction. In conclusion, the improvement in TIPS patency by using covered prostheses is maintained over time with a decreased risk of encephalopathy, while the risk of death was not increased.

Consensus conference on TIPS management: Techniques, indications, contraindications

“…Both TIPS and surgical shunts are extremely effective in controlling variceal bleeding (control rate approaching 95%). TIPS represents the first choice due to the intolerable surgical risk in decompensated cirrhotic patients [18,98]. Regrettably, following development of systemic complications or deterioration of liver function, mortality remains high even when TIPS is applied as a rescue therapy.…”

“…Dedicated ePTFE-covered stents should be preferred over bare stents in order to reduce the risk of shunt dysfunction (1b, A) [18][19][20][29][30][31].…”

The role of transjugular intrahepatic portosystemic shunt (TIPS) in the management of portal hypertension: Update 2009

“…Thomas D. Boyer 1 and Ziv J. Haskal 2 The 2009 update of the American Association for the Study of Liver Diseases (AASLD) Practice Guideline "The Role of Transjugular Intrahepatic Portosystemic Shunt (TIPS) in the Management of Portal Hypertension" is now posted online at www.aasld.org. This is the first update of the original guideline published in 2005.…”

“…The lower risk of shunt dysfunction and perhaps improved outcomes using covered as opposed to bare stents are the basis for this recommendation. 2,3 Creation of a TIPS increases the risk of hepatic encephalopathy but the prophylactic use of nonabsorbable disaccharides or antibiotics does not appear to reduce this risk and is not recommended. 4 The value of TIPS versus a surgical shunt in the prevention of variceal rebleeding in patients who have failed medical therapy has been clarified by the publication of a controlled trial comparing TIPS to distal splenorenal shunt (DSRS).…”

MR Evaluation of Portal Hypertensive Collateral Shunting Vessels for Predicting Outcome after Transjugular Intrahepatic Portosystemic Shunt

“…Finally, we used only bare stents in our patients, but improved patency and clinical success rates have been reported recently using stents with polytetra‰uoroethylene. 22,23 …”