Polytetrafluoroethylene-Covered Stent Graft Versus Bare Stent in Transjugular Intrahepatic Portosystemic Shunt: Systematic Review and Meta-Analysis

Triantafyllou, Tania; Aggarwal, Piyush; Gupta, Ekansh; Svetanoff, Wendy Jo; Bhirud, Deepak Prakash; Singhal, Saurabh

doi:10.1089/lap.2017.0560

Cited by 26 publications

(13 citation statements)

References 41 publications

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“…HE is the most common complication, but stent type and operators' skills also affect the outcomes of TIPS [21]. Rebleeding mostly occurs because of the stent stenosis and occlusion [7]. Thus, a commonly used therapy for such cases is TIPS revision.…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, covered stent graft such as polytetrafluoroethylene-(PTFE-) covered stent has been developed to improve the stent patency. Triantafyllou et al concluded that the 1-year primary patency of stent rose from 52% to 84% by using covered stent instead of the bare stent, while rebleeding rate dropped from 18% to 9% [7]. In clinical practice, patients at high risk, NSBB nonresponder, and patients with extraluminal collaterals prefer to receive TIPS treatment first since it has been established that endoscopic treatments are less effective in these patients [8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic Treatment as the Rescue Therapy for Recurrent Bleeding after Transjugular Intrahepatic Portosystemic Shunt (TIPS)

Huang

Jiang

et al. 2021

Gastroenterology Research and Practice

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Background. Transjugular intrahepatic portosystemic shunt (TIPS) is suggested as the salvage therapy for gastroesophageal variceal bleeding in cirrhosis. However, rebleeding might occur in some patients after TIPS. Currently, there is a lack of evidence in the endoscopic management of recurrent bleeding in these patients. Aims. To evaluate the efficacy of endoscopic treatment in cirrhotic patients with recurrent bleeding after TIPS. Methods. Cirrhotic patients with gastroesophageal varices who received endoscopic treatment for recurrent bleeding after TIPS were included. Results. 6 patients were enrolled in this study. The median age of the patients was 47 years (range 27 to 65 years), and the duration of follow-up time was 346 (17-773) days. Stent stenosis or occlusion was found in 5 out of 6 patients after TIPS. Salvage endoscopic treatment, including esophageal variceal ligation (EVL), gastric variceal cyanoacrylate injection, esophageal variceal sclerotherapy, and balloon-occluded retrograde transvenous obliteration- (BRTO-) assisted endoscopic cyanoacrylate injection. Among included patients, 2 died shortly after EVL (14 and 19 days) due to variceal bleeding. Among other 4 patients, 2 had rebleeding episodes at 422 and 789 days, respectively. Conclusion. Endoscopic treatment may be an option for recurrent bleeding after TIPS in selected patients. Further studies are needed to carefully define the indication and efficacy of this option.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Endoscopic Treatment as the Rescue Therapy for Recurrent Bleeding after Transjugular Intrahepatic Portosystemic Shunt (TIPS)

Huang

Jiang

et al. 2021

Gastroenterology Research and Practice

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“…Remarks Covered stents are less prone to occlusion as the PTFE covering prevents pseudo intimal hyperplasia and acute thrombosis which is mostly related to bile intravasation into the stent. 122,123 Studies have shown covered stents to have a better patency and survival rates in patients with variceal bleeding and ascites. [124][125][126] Q11.…”

Section: Remarksmentioning

confidence: 99%

Indian College of Radiology and Imaging Evidence-Based Guidelines for Interventions in Portal Hypertension and Its Complications

Mukund

Rana

Mohan

et al. 2021

Indian J Radiol Imaging

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Portal hypertension is a complication of chronic liver disease. Various radiological interventions are being done to aid in the diagnosis of portal hypertension; further, an interventional radiologist can offer various treatments for the complications of portal hypertension. Diagnosis of portal hypertension in its early stage may require hepatic venous pressure gradient measurement. Measurement of gradient also guides in diagnosing the type of portal hypertension, measuring response to treatment and prognostication. This article attempts to provide evidence-based guidelines on the management of portal hypertension and treatment of its complications.

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“…57 A recent meta-analysis comparing covered stents and metallic stents analyzed 14 studies (4 randomized clinical trials, 2 prospective nonrandomized studies, and 8 retrospective studies; 2,519 patients total) and demonstrated that odds of patency (odds ratio, OR ¼ 4.75) and survival (OR ¼ 1.85) were significantly higher for PTFE-covered stent grafts, while odds of rebleeding were significantly lower (OR ¼ 0.37). 84 Thus, the role of embolotherapy remains uncertain in our current era and questions about its use have been raised given involved cost, radiation exposure, procedure duration, and risk of postembolization syndrome. 72,85 TIPS in VH, Rescue, and Emerging Early TIPS TIPS is highly effective for rescue therapy for both EVH and GVH.…”

Section: Embolotherapy and Tipsmentioning

confidence: 99%

Endovascular Treatment for Variceal Hemorrhage: TIPS, BRTO, and Combined Approaches

Lipnik

Pandhi

Khabbaz

et al. 2018

Semin intervent Radiol

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Variceal hemorrhage is a feared complication of portal hypertension, with high rates of morbidity and mortality. Optimal management requires a thoughtful, multidisciplinary approach. In cases of refractory or recurrent esophageal hemorrhage, endovascular approaches such as transjugular intrahepatic portosystemic shunt (TIPS) have a well-defined role. For hemorrhage related to gastric varices, the optimal treatment remains to be established; however, there is increasing adoption of balloon-occluded retrograde transvenous obliteration (BRTO). This article will review the concept, history, patient selection, basic technique, and outcomes for TIPS, BRTO, and combined TIPS + BRTO procedures for variceal hemorrhage.

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Polytetrafluoroethylene-Covered Stent Graft Versus Bare Stent in Transjugular Intrahepatic Portosystemic Shunt: Systematic Review and Meta-Analysis

Abstract: CS is associated with better primary patency and survival and lesser rate of rebleeding than BS in patients undergoing TIPS procedure. There is no difference in new-onset hepatic encephalopathy.

Cited by 26 publications

References 41 publications

Endoscopic Treatment as the Rescue Therapy for Recurrent Bleeding after Transjugular Intrahepatic Portosystemic Shunt (TIPS)

Endoscopic Treatment as the Rescue Therapy for Recurrent Bleeding after Transjugular Intrahepatic Portosystemic Shunt (TIPS)

Indian College of Radiology and Imaging Evidence-Based Guidelines for Interventions in Portal Hypertension and Its Complications

Endovascular Treatment for Variceal Hemorrhage: TIPS, BRTO, and Combined Approaches

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