Long-term shunt patency and overall survival of transjugular intrahepatic portosystemic shunt placement using covered stents with bare stents versus covered stents alone

• Published in: Clinical radiology Vol. 73; no. 6; pp. 580 - 587
• Main Authors: Li, Y.-H., Xu, Z.-Y., Wu, H.-M., Yang, L.-H., Xu, Y., Wu, X.-N., Wan, Y.-M.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-06-2018
• Subjects: Adolescent; Adult; Aged; Ascites - etiology; Ascites - surgery; Carcinoma, Hepatocellular - complications; Female; Humans; Hypertension, Portal - surgery; Liver Cirrhosis - surgery; Liver Neoplasms - complications; Male; Middle Aged; Portasystemic Shunt, Transjugular Intrahepatic; Reoperation; Retrospective Studies; Risk Factors; Stents; Survival Analysis; Treatment Outcome; Young Adult
• ISSN: 0009-9260; 1365-229X
• DOI: 10.1016/j.crad.2018.01.014

To investigate the long-term shunt patency and overall survival of transjugular intrahepatic portosystemic shunt (TIPS) placement using covered stents with or without bare stents over a follow-up period up to 7 years.
A total of 154 patients undergoing TIPS placement were enrolled and analysed retrospectively. They were divided into two groups: those undergoing TIPS placement using covered with bare stents (group A, n=42) and those without bare stents (group B, n=112).
The cumulative 5-year primary patency rate was significantly lower in group A than in group B (group A: 0% versus group B: 66.7%; p<0.001). The cumulative 5-year overall survival rates were comparable between the two groups (group A: 76% versus group B: 58.7%; p=0.214). The baseline portal vein thrombosis (hazard ratio [HR]:4.610; 95% confidence interval [CI]:2.691–7.897; p=0.000), portal pressure decrement (HR: 0.911; 95% CI: 0.845–0.982; p=0.015), and group (HR: 0.419; 95% CI: 0.239–0.736; p=0.002) were independent predictors for shunt dysfunction, while hepatocellular carcinoma (HR: 6.615; 95% CI: 2.863–15.283; p=0.000) and ascites (HR: 2.166; 95% CI: 1.298–3.615; p=0.003) were independent predictors for mortality.
Although TIPS placement using covered with bare stents led to lowered long-term shunt patency than using covered stents alone, the overall survival rates were similar.
•Illustrating TIPS placement using covered with bare stents led to decreased long-term primary patency rate.•Demonstrating similar long-term overall survival between the two modes of TIPS placement.•Showing high success rates of TIPS revision and similar secondary patency rates between the two modes of TIPS placement.•Identifying the baseline PVT, PPD, and group as independent predictors for shunt dysfunction.•Identifying hepatocellular carcinoma and ascites as independent predictors for overall survival.