The effect of stent position on clinical efficacy of transjugular intrahepatic portosystemic shunts (TIPS) using the Expanded Polytetrafluoroethylene–Covered Stent

PurposeTo evaluate the effect of stent position on TIPS using the Expanded Polytetrafluoroethylene–Covered Stent.MaterialsA retrospective review including 57 TIPSs created with ePTFE–Covered Stent grafts between January 2008 and December 2011 was performed. The diameter of the stent graft used was 8mm (Fluency stent, Bard), 12 patients underwent an additional bare metal stent implantation, simultaneously. The angiographic images during initial TIPS creation were reviewed independently by two observers who were blinded to outcome.Length of covered-stent in hepatic vein,in portal vein,and length of stent in hepatic vein,in portal vein were measured. Cox proportional regression analysis was performed to assess the effect of these technical parameters on primary patency, survival, and HE.ResultsThe procedure was successful in all patients. The mean portosystemic pressure decreased from 39.18mmHg to 24.75mmHg (P<0.001). Mortality rates at 2 weeks after TIPS creation were 6.9% (4/57). At a mean follow-up of 64 months,Primary patency rates at 1-5 years were 84%,75%,66%,63%,54%, respectively.Survival rates at 1-5 years after TIPS creation were 79%,73%,73%,70%,70%, respectively. Postprocedural encephalopathy occurred in 12 patients (22%).There was a significant association between the length of covered-stent in hepatic vein and primary patency (OR=0.424; P=0.008).There was a significant association between the length of stent in portal vien and survival(OR=1.50; P=0.021). No significant correlation was found between these technical parameters and HE.ConclusionsIncrease the length of covered-stent in hepatic vein and decrease the length of stent in portal vein could improve primary patency and survival, respectively. PurposeTo evaluate the effect of stent position on TIPS using the Expanded Polytetrafluoroethylene–Covered Stent. To evaluate the effect of stent position on TIPS using the Expanded Polytetrafluoroethylene–Covered Stent. MaterialsA retrospective review including 57 TIPSs created with ePTFE–Covered Stent grafts between January 2008 and December 2011 was performed. The diameter of the stent graft used was 8mm (Fluency stent, Bard), 12 patients underwent an additional bare metal stent implantation, simultaneously. The angiographic images during initial TIPS creation were reviewed independently by two observers who were blinded to outcome.Length of covered-stent in hepatic vein,in portal vein,and length of stent in hepatic vein,in portal vein were measured. Cox proportional regression analysis was performed to assess the effect of these technical parameters on primary patency, survival, and HE. A retrospective review including 57 TIPSs created with ePTFE–Covered Stent grafts between January 2008 and December 2011 was performed. The diameter of the stent graft used was 8mm (Fluency stent, Bard), 12 patients underwent an additional bare metal stent implantation, simultaneously. The angiographic images during initial TIPS creation were reviewed independently by two observers who were blinded to outcome.Length of covered-stent in hepatic vein,in portal vein,and length of stent in hepatic vein,in portal vein were measured. Cox proportional regression analysis was performed to assess the effect of these technical parameters on primary patency, survival, and HE. ResultsThe procedure was successful in all patients. The mean portosystemic pressure decreased from 39.18mmHg to 24.75mmHg (P<0.001). Mortality rates at 2 weeks after TIPS creation were 6.9% (4/57). At a mean follow-up of 64 months,Primary patency rates at 1-5 years were 84%,75%,66%,63%,54%, respectively.Survival rates at 1-5 years after TIPS creation were 79%,73%,73%,70%,70%, respectively. Postprocedural encephalopathy occurred in 12 patients (22%).There was a significant association between the length of covered-stent in hepatic vein and primary patency (OR=0.424; P=0.008).There was a significant association between the length of stent in portal vien and survival(OR=1.50; P=0.021). No significant correlation was found between these technical parameters and HE. The procedure was successful in all patients. The mean portosystemic pressure decreased from 39.18mmHg to 24.75mmHg (P<0.001). Mortality rates at 2 weeks after TIPS creation were 6.9% (4/57). At a mean follow-up of 64 months,Primary patency rates at 1-5 years were 84%,75%,66%,63%,54%, respectively.Survival rates at 1-5 years after TIPS creation were 79%,73%,73%,70%,70%, respectively. Postprocedural encephalopathy occurred in 12 patients (22%).There was a significant association between the length of covered-stent in hepatic vein and primary patency (OR=0.424; P=0.008).There was a significant association between the length of stent in portal vien and survival(OR=1.50; P=0.021). No significant correlation was found between these technical parameters and HE. ConclusionsIncrease the length of covered-stent in hepatic vein and decrease the length of stent in portal vein could improve primary patency and survival, respectively. Increase the length of covered-stent in hepatic vein and decrease the length of stent in portal vein could improve primary patency and survival, respectively.