title: Covered transjugular intrahepatic portosystemic stents maintain lower portal pressure and require fewer reinterventions than uncovered stents.
abstract: 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.
authors.affiliation: Medizinische Klinik mit Schwerpunkt Gastroenterologie, Hepatologie und Endokrinologie, Charité Universitätsmedizin Berlin, Germany. johann.ockenga@charite.de
authors.forename: J
authors.initials: J
authors.lastname: Ockenga
authors.forename: T J
authors.initials: TJ
authors.lastname: Kroencke
authors.forename: T
authors.initials: T
authors.lastname: Schuetz
authors.forename: M
authors.initials: M
authors.lastname: Plauth
authors.forename: E
authors.initials: E
authors.lastname: Kasim
authors.forename: J
authors.initials: J
authors.lastname: Petersein
authors.forename: H H-J
authors.initials: HH
authors.lastname: Schmidt
authors.forename: H
authors.initials: H
authors.lastname: Lochs
mesh_terms: 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
chemical_list: D020099:Coated Materials, Biocompatible