title: Improved clinical outcome using polytetrafluoroethylene-coated stents for TIPS: results of a randomized study.
abstract: OBJECTIVE
  A 50% dysfunction rate at 1 year is one of the main drawbacks of the transjugular intrahepatic portosystemic shunt procedure. Preliminary experimental and clinical studies suggest that the use of stents covered with polytetrafluoroethylene could tremendously decrease this risk.
  
  
  METHODS
  Eighty patients with cirrhosis and uncontrolled bleeding (n = 23), recurrent bleeding (n = 25), or refractory ascites (n = 32) were randomized to be treated by transjugular intrahepatic portosystemic shunts with either a polytetrafluoroethylene-covered stent (group 1; 39 patients) or a usual uncovered prosthesis (group 2; 41 patients). Follow-up Doppler ultrasound was scheduled at day 7, at 1 month, and then every 3 months for 2 years. Angiography and portosystemic pressure gradient measurements were performed 6, 12, and 24 months after the transjugular intrahepatic portosystemic shunt procedure and whenever dysfunction was suspected. Dysfunction was defined as a >50% reduction of the lumen of the shunt at angiography or a portosystemic pressure gradient >12 mm Hg.
  
  
  RESULTS
  After a median follow-up of 300 days, 5 patients (13%) in group 1 and 18 (44%) in group 2 experienced shunt dysfunction (P < 0.001). Clinical relapse occurred in 3 patients (8%) in group 1 and 12 (29%) in group 2 (P < 0.05). Actuarial rates of encephalopathy were 21% in group 1 and 41% in group 2 at 1 year (not significant). Estimated probabilities of survival were 71% and 60% at 1 year and 65% and 41% at 2 years in groups 1 and 2, respectively (not significant).
  
  
  CONCLUSIONS
  The use of polytetrafluoroethylene-covered prostheses improves transjugular intrahepatic portosystemic shunt patency and decreases the number of clinical relapses and reinterventions without increasing the risk of encephalopathy.
authors.affiliation: Service d'Hépato-Gastro-Entérologie, Fédération Digestive, Centre Hospitalier Universitaire Purpan et U531 Institut National de la Santé et de la Recherche Médicale, Toulouse, France. bureau.c@chu-toulouse.fr
authors.forename: Christophe
authors.initials: C
authors.lastname: Bureau
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Garcia-Pagan
authors.forename: Philippe
authors.initials: P
authors.lastname: Otal
authors.forename: Gilles
authors.initials: G
authors.lastname: Pomier-Layrargues
authors.forename: Valérie
authors.initials: V
authors.lastname: Chabbert
authors.forename: Carlos
authors.initials: C
authors.lastname: Cortez
authors.forename: Pierre
authors.initials: P
authors.lastname: Perreault
authors.forename: Jean Marie
authors.initials: JM
authors.lastname: Péron
authors.forename: Juan G
authors.initials: JG
authors.lastname: Abraldes
authors.forename: Louis
authors.initials: L
authors.lastname: Bouchard
authors.forename: José Ignacio
authors.initials: JI
authors.lastname: Bilbao
authors.forename: Jaume
authors.initials: J
authors.lastname: Bosch
authors.forename: Hervé
authors.initials: H
authors.lastname: Rousseau
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Vinel
mesh_terms: D000328:Adult; D000368:Aged; D020099:Coated Materials, Biocompatible; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000601:surgery*; D006501:Hepatic Encephalopathy / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000150:complications; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000295:instrumentation / Q000401:mortality; D011475:Prosthesis Failure; D015607:Stents / Q000009:adverse effects; D016019:Survival Analysis; D016896:Treatment Outcome; D014648:Varicose Veins / Q000150:complications*
chemical_list: D020099:Coated Materials, Biocompatible; D011138:Polytetrafluoroethylene