Polytetrafluoroethylene-Covered Stent Grafts for TIPS Procedure: 1-Year Patency and Clinical Results

Angeloni, S.; Merli, Manuela; Salvatori, Filippo Maria; Santis, Adriano De; Fanelli, Fabrizio; Pepino, Daniela; Attili, Adolfo Francesco; Rossi, Plinio; Riggio, Oliviero

doi:10.1111/j.1572-0241.2004.04056.x

Cited by 74 publications

(58 citation statements)

References 40 publications

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“…Accordingly, understanding the predisposing factors leading to TIPS dysfunction and efforts to solve those problems are necessary to maintain long-term patency after TIPS placement. Currently, the best solution for TIPS dysfunction seems to be the use of polytetrafluoroethylene-covered stent grafts that isolate blood from hepatic tissue, therefore blocking the tentative triggering mechanisms of pseudointimal and intimal hyperplasia or thrombosis (19)(20)(21)(22)(23)(24)(25)(26)(27). Recently, a meta-analysis of six studies demonstrated not only a significant improvement of primary patency (hazard ratio [HR], 0.28) and a significant reduction of risk of hepatic encephalopathy (HR, 0.65), but also a significant decrease of mortality in the covered-stent group (HR, 0.76) (25).…”

Section: Discussionmentioning

confidence: 99%

“…Among many theories, widely accepted ones are thrombosis, pseudointimal hyperplasia caused by bile leaks of transected bile ducts into the stent lumen, and intimal hyperplasia of the hepatic vein outflow tract (16)(17)(18). Recently, use of polytetrafluoroethylene (PTFE)-covered stents has decreased TIPS dysfunction by allowing endoluminal endothelial lining and preventing bile leak into the stent (19)(20)(21)(22)(23)(24)(25)(26)(27).…”

Section: Introductionmentioning

confidence: 99%

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Stent Dysfunction After Transjugular Intrahepatic Portosystemic Shunt: A 14-Year Experience from a Single Tertiary Medical Center

Kim

Gwon

et al. 2017

Iran J Radiol

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Background: The predisposing factors leading to transjugular intrahepatic portosystemic shunt (TIPS) dysfunction, other than the use of bare stents, which are often the only available options, have not been elucidated well to date. Objectives: To analyze clinical outcomes after TIPS created with bare stents and to assess risk factors for stent dysfunction. Patients and Methods: A total of 102 patients undergoing TIPS between January 1999 and December 2012 were retrospectively assessed. The incidence of stent dysfunction was evaluated, and associated risk factors were analyzed. Results: Symptom recurrence was observed in 51 (50%) patients, and TIPS revision was required in 37 (36%) during the mean followup period of 1889 days. The median stent patency and survival times were 470 and 1783 days, respectively. The only independent risk factor for stent dysfunction was portal trunk (right, left, or main portal trunk) access (P = 0.006). The median stent patency with segmental branch access (538 days) was significantly longer than that with portal trunk access (245 days) (P = 0.007). There were no significant differences in patient survival (P = 0.648), worsening of encephalopathy (P = .0742), or major complications (P = 1.000). Conclusion: TIPS created with segmental portal venous access has superior patency over that of TIPS with portal trunk access. However, we found no significant difference in patient survival, worsening of encephalopathy, or major complications between segmental access and portal trunk access.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Stent Dysfunction After Transjugular Intrahepatic Portosystemic Shunt: A 14-Year Experience from a Single Tertiary Medical Center

Kim

Gwon

et al. 2017

Iran J Radiol

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“…Aufgrund der Entwicklung von PTFE-beschichteten Stents ist die Stenoserate und somit die Dysfunktion von TIPS weiter gesunken (Angeloni et al 2004, Bureau et al 2004 (Jalan et al 1995, Sanyal et al 1994, Somberg et al 1995 …”

Section: Komplikationen Der Tips-implantationunclassified

“…Offenheitsrate folglich höher als bei Bare-Stents ist, kann dies eine weitere Erklärung für die relativ geringe Stenoserate in unserer Studie sein (Barrio et al 2005, Charon et al 2004, Hausegger et al 2004 (Angeloni et al 2004, Barrio et al 2005, Crenshaw et al 1996, Nazarian et al 1997, Ochs et al 1995. Der Vergleich der Shuntfunktion von PTFEbeschichteten Stents nach zwölf Monaten zeigte ebenfalls übereinstimmende Ergebnisse mit großen Studien.…”

Section: Da Die Rate Der Stentdysfunktion Bei Beschichteten Stents Niunclassified

Verlaufsbeobachtung von Patienten mit Anlage eines Transjugulären Intrahepatischen Portosystemischen Shunts (TIPS) zur Beeinflussung des Aszites bei dekompensierter Leberzirrhose

Ballauf¹,

Holle²,

Emmrich³

et al. 2009

Z Gastroenterol

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“…In the era of bare metal stents, TIPS dysfunction was a major problem that led to relatively low primary patency rates, typically less than 50% at one year [1,5,7] . However, expanded polytetrafluoroethylene (PTFE) covered TIPS have improved patency rates and clinical outcomes compared to bare metal TIPS [1][2][3][4][8][9][10] . Primary patency rates at two years have now been shown to range from 62%-89% [7,[10][11][12][13][14] .…”

Section: Introductionmentioning

confidence: 99%

Passive expansion of submaximally dilated transjugular intrahepatic portosystemic shunts and assessment of clinical outcomes

Hsu

Weber

Nadolski³

2016

Journal of Vascular and Interventional Radiology

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AIMTo assess for passive expansion of sub-maximally dilated transjugular intrahepatic portosystemic shunts (TIPS) and compare outcomes with maximally dilated TIPS. METHODS Polytetrafluoroethylene covered TIPS (Viatorr) fromJuly 2002 to December 2013 were retrospectively reviewed at two hospitals in a single institution. Two hundred and thirty patients had TIPS maximally dilated to 10 mm (mTIPS), while 43 patients who were at increased risk for hepatic encephalopathy (HE), based on clinical evaluation or low pre-TIPS portosystemic gradient (PSG), had 10 mm TIPS sub-maximally dilated to 8 mm (smTIPS). Hsu MC et al . Passive expansion of sub-maximally dilated TIPS primary assisted patency, and severe post-TIPS HE. A subset of fourteen patients with smTIPS underwent follow-up computed tomography imaging after TIPS creation, and were grouped based on time of imaging (< 6 mo and > 6 mo). Change in diameter and crosssectional area were measured with 3D imaging software to evaluate for passive expansion. RESULTSPatient characteristics were similar between the smTIPS and mTIPS groups, except for pre-TIPS portosystemic gradient, which was lower in the smTIPS group (19.4 mmHg ± 6.8 vs 22.4 mmHg ± 7.1, P = 0.01). Primary patency and primary assisted patency between smTIPS and mTIPS was not significantly different (P = 0.64 and 0.55, respectively). Four of the 55 patients (7%) with smTIPS required TIPS reduction for severe refractory HE, while this occurred in 6 of the 218 patients (3%) with mTIPS (P = 0.12). For the 14 patients with follow-up computed tomography (CT) imaging, the median imaging follow-up was 373 d. There was an increase in median TIPS diameter, median percent diameter change, median area, and median percent area change in patients with CT follow-up greater than 6 mo after TIPS placement compared to follow-up within 6 mo (8.45 mm, 5.58%, 56.04 mm 2 , and 11.48%, respectively, P = 0.01). CONCLUSIONPassive expansion of smTIPS does occur but clinical outcomes of smTIPS and mTIPS were similar. Sub-maximal dilation can prevent complications related to overshunting in select patients. Core tip: Sub-maximal dilation of transjugular intrahepatic portosystemic shunts (TIPS) is a method to reduce the risk of over-shunting and hepatic encephalopathy. The current study is a retrospective review to compare clinical outcomes of sub-maximally dilated TIPS (smTIPS) with maximally dilated TIPS (mTIPS) and assess for passive expansion of smTIPS. The study demonstrated that passive expansion of smTIPS does occur, however shunts may not fully expand and expansion may occur even after 6 mo. Clinical outcomes of smTIPS and mTIPS were similar, suggesting sub-maximal dilation may be an acceptable method to prevent complications related to over-shunting in select patients.Hsu MC, Weber CN, Stavropoulos SW, Clark TW, Trerotola SO, ShlanskyGoldberg RD, Soulen MC, Nadolski GJ. Passive expansion of submaximally dilated transjugular intrahepatic portosystemic shunts and assessment of clinical outcomes.

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Polytetrafluoroethylene-Covered Stent Grafts for TIPS Procedure: 1-Year Patency and Clinical Results

Abstract: PTFE-covered stents are able to solve pseudointimal hyperplasia within the stent tract, but have a high incidence of hepatic or portal vein stenosis. Improvements in stent design and insertion techniques are necessary to fully achieve the potential benefit of this new device.

Cited by 74 publications

References 40 publications

Stent Dysfunction After Transjugular Intrahepatic Portosystemic Shunt: A 14-Year Experience from a Single Tertiary Medical Center

Stent Dysfunction After Transjugular Intrahepatic Portosystemic Shunt: A 14-Year Experience from a Single Tertiary Medical Center

Verlaufsbeobachtung von Patienten mit Anlage eines Transjugulären Intrahepatischen Portosystemischen Shunts (TIPS) zur Beeinflussung des Aszites bei dekompensierter Leberzirrhose

Passive expansion of submaximally dilated transjugular intrahepatic portosystemic shunts and assessment of clinical outcomes

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