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Long-Term Patency and Clinical Analysis of Expanded Polytetrafluoroethylene-Covered Transjugular Intrahepatic Portosystemic Shunt Stent Grafts. J Vasc Interv Radiol 2015 Sep;26(9):1257-65; quiz 1265

Date

05/21/2015

Pubmed ID

25990133

DOI

10.1016/j.jvir.2015.04.005

Scopus ID

2-s2.0-84940452531   40 Citations

Abstract

PURPOSE: To evaluate long-term patency and symptomatic recurrence rates following transjugular intrahepatic portosystemic shunt (TIPS) creation with expanded polytetrafluoroethylene (ePTFE)-covered stent grafts and to determine the necessity of extended clinical follow-up beyond 2 years after TIPS creation.

MATERIALS AND METHODS: A retrospective review including 262 TIPSs created with ePTFE-covered stent grafts between July 2002 and October 2012 was performed. Primary, primary assisted, and secondary patency rates were calculated. Assessment of clinical data included technical, hemodynamic, and clinical success rates, as well as mortality after TIPS creation.

RESULTS: Primary patency rates at 2, 4, and 6 years were 74%, 62%, and 50%, respectively. Primary assisted patency rates at 2, 4, and 6 years were 93%, 85%, and 78%, respectively. Secondary patency rates at 2, 4, and 6 years were 99%, 91%, and 84%, respectively. Technical and hemodynamic success rates were 99% and 93%, respectively. Clinical success rates for refractory ascites were 66% (complete response) and 90% (partial response); clinical success rate for bleeding/varices was 90%. Mortality rates at 2, 4, and 6 years after TIPS creation were 27%, 38%, and 46%, respectively. At the median wait time until transplantation, patients had an 84% chance of being alive. TIPS dysfunction developed in 21% of patients; 30% of revisions occurred later than 2 years during follow-up.

CONCLUSIONS: Beyond 2 years after TIPS creation, patency rates gradually decrease, mortality rates continue to increase, and the chance of recurrent ascites or bleeding remains present. Together, these findings suggest that continued clinical follow-up beyond 2 years is necessary in patients with a TIPS created with an ePTFE-covered stent graft.

Author List

Weber CN, Nadolski GJ, White SB, Clark TW, Mondschein JI, Stavropoulos SW, Shlansky-Goldberg RD, Trerotola SO, Soulen MC

Author

Sarah B. White MD, MS, FSIR, FCIRSE Vice Chair, Professor in the Radiology department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Aged, 80 and over
Child
Coated Materials, Biocompatible
Disease-Free Survival
Female
Graft Rejection
Graft Survival
Humans
Hypertension, Portal
Longitudinal Studies
Male
Middle Aged
Polytetrafluoroethylene
Portasystemic Shunt, Transjugular Intrahepatic
Prosthesis Design
Recurrence
Reoperation
Retrospective Studies
Risk Factors
Survival Rate
Treatment Outcome
United States
Vascular Patency
Young Adult