Covered transjugular intrahepatic portosystemic stents maintain lower portal pressure and require fewer reinterventions than uncovered stents.
BACKGROUND
The purpose of this study was to evaluate the patency, functional and haemodynamic results of expanded-polytetrafluoroethylene (ePTFE)-covered transjugular intrahepatic portosystemic shunts in patients with liver cirrhosis.


METHODS
Thirteen patients with an ePTFE-covered transjugular intrahepatic portosystemic shunt stent (TIPSS) were prospectively evaluated at 6 and 12 months and compared with matched controls with mesh-wire uncovered TIPSS.


RESULTS
At 6 months, ePTFE-TIPSS showed a significantly lower porto-caval pressure gradient (PCPG) (9 (3-21) mmHg, P = 0.006), a lower rate of dysfunction (8% versus 54%, P = 0.03) and required fewer reinterventions (2 versus 13, P = 0.02); similar results were obtained after 12 months. This resulted in a reduction in the median cost for angiographic surveillance in the covered TIPSS group at 6 and 12 months (36% and 56% compared to the uncovered TIPSS group, P = 0.002), but total procedure-related costs were higher with the ePTFE-TIPSS (6 months: 3730 (3245-6759) versus 1850 (1466-5479) euro/patient; 12 months: 3945 (3460-6759) versus 2295 (1728-5694) euro/patient) due to the higher initial cost of the ePTFE-covered TIPSS.


CONCLUSIONS
The insertion of ePTFE-covered TIPSS results in better maintenance of lowered portal pressure and fewer reinterventions in patients with liver cirrhosis. There is strong evidence that the use of ePTFE-TIPSS does not require regular surveillance to maintain primary patency, which may then improve cost-effectiveness.
Ockenga
J
J
Medizinische Klinik mit Schwerpunkt Gastroenterologie, Hepatologie und Endokrinologie, Charité Universitätsmedizin Berlin, Germany. johann.ockenga@charite.de
Kroencke
T J
TJ
Schuetz
T
T
Plauth
M
M
Kasim
E
E
Petersein
J
J
Schmidt
H H-J
HH
Lochs
H
H
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D020099:Coated Materials, Biocompatible; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000601:surgery*; D007231:Infant, Newborn; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008365:Manometry; D008422:Materials Testing; D008875:Middle Aged; D017082:Portal Pressure / Q000502:physiology; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000295:instrumentation* / Q000379:methods; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015607:Stents; D016896:Treatment Outcome
D020099:Coated Materials, Biocompatible