Improved clinical outcome with transjugular intrahepatic portosystemic stent-shunt utilizing polytetrafluoroethylene-covered stents

• Published in: European journal of gastroenterology & hepatology Vol. 18; no. 3; pp. 225 - 232
• Main Authors: Tripathi, Dhiraj, Ferguson, James, Barkell, Holly, Macbeth, Kim, Ireland, Hamish, Redhead, Doris N, Hayes, Peter C
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins, Inc 01-03-2006; Lippincott Williams & Wilkins
• Subjects: Biological and medical sciences; Case-Control Studies; Coated Materials, Biocompatible; Esophageal and Gastric Varices - diagnostic imaging; Esophageal and Gastric Varices - surgery; Female; Follow-Up Studies; Gastroenterology. Liver. Pancreas. Abdomen; Gastrointestinal Hemorrhage - diagnostic imaging; Gastrointestinal Hemorrhage - surgery; Humans; Hypertension, Portal - diagnostic imaging; Hypertension, Portal - surgery; Liver Transplantation; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Polytetrafluoroethylene; Portasystemic Shunt, Transjugular Intrahepatic - instrumentation; Portasystemic Shunt, Transjugular Intrahepatic - methods; Postoperative Complications - diagnostic imaging; Radiography; Recurrence; Regression Analysis; Reoperation; Stents; Treatment Outcome; Ultrasonography; Prognosis; Portal circulation disease; Tetrafluoroethylene polymer; Instrumentation therapy; Cardiovascular disease; Intrahepatic portosystemic shunt; Stent; Vascular disease; portosystemic shunt; Gastroenterology; Portal hypertension; polytetrafluoroethylene; Digestive diseases
• ISSN: 0954-691X; 1473-5687
• DOI: 10.1097/00042737-200603000-00001

BACKGROUND AND AIMSTransjugular intrahepatic portosystemic stent-shunt (TIPSS) with standard uncovered stents has a 50% one-year primary patency rate, and is complicated by hepatic encephalopathy in 35% of patients. Newer covered stents appear to have improved patency. This large study aimed to assess the shunt function and clinical efficacy of polytetrafluoroethylene-covered stents in a single centre.
METHODSA total of 316 patients with uncovered stents before the introduction of covered stents (group 1) and 157 patients with the Viatorr Gore polytetrafluoroethylene-covered stents at the time of TIPSS creation (group 2) were studied.
RESULTSThe mean follow-up was 22.8±25.4 and 13.1±12.5 months, respectively (P<0.01). Shunt insufficiency was greater in group 1 [54 versus 8% at 12 months; relative hazard (RH) 8.6; 95% confidence interval (CI) 4.8–15.5; P<0.001]. The incidence of variceal rebleeding was greater in group 1 (11 versus 6% at 12 months; RH 2.4; 95% CI 1.1–5.1; P<0.05). The incidence of hepatic encephalopathy was greater in group 1 (32 versus 22% at 12 months; RH 1.5; 95% CI 1.1–2.3; P<0.05). Mortality was similar in the two groups.
CONCLUSIONThe Viatorr type of polytetrafluoroethylene-covered stent results in vastly improved patency compared with uncovered stents, with reduced rates of variceal rebleeding and hepatic encephalopathy. This type of covered stent has the potential for superior clinical efficacy compared with uncovered stents.