Improved clinical outcome with transjugular intrahepatic portosystemic stent-shunt utilizing polytetrafluoroethylene-covered stents.
OBJECTIVE
Transjugular intrahepatic portosystemic stent-shunt (TIPSS) with standard uncovered stents has a 50% one-year primary patency rate, and is complicated by hepatic encephalopathy in 35% of patients. Newer covered stents appear to have improved patency. This large study aimed to assess the shunt function and clinical efficacy of polytetrafluoroethylene-covered stents in a single centre.


METHODS
A total of 316 patients with uncovered stents before the introduction of covered stents (group 1) and 157 patients with the Viatorr Gore polytetrafluoroethylene-covered stents at the time of TIPSS creation (group 2) were studied.


RESULTS
The mean follow-up was 22.8+/-25.4 and 13.1+/-12.5 months, respectively (P<0.01). Shunt insufficiency was greater in group 1 [54 versus 8% at 12 months; relative hazard (RH) 8.6; 95% confidence interval (CI) 4.8-15.5; P<0.001]. The incidence of variceal rebleeding was greater in group 1 (11 versus 6% at 12 months; RH 2.4; 95% CI 1.1-5.1; P<0.05). The incidence of hepatic encephalopathy was greater in group 1 (32 versus 22% at 12 months; RH 1.5; 95% CI 1.1-2.3; P<0.05). Mortality was similar in the two groups.


CONCLUSIONS
The Viatorr type of polytetrafluoroethylene-covered stent results in vastly improved patency compared with uncovered stents, with reduced rates of variceal rebleeding and hepatic encephalopathy. This type of covered stent has the potential for superior clinical efficacy compared with uncovered stents.
Tripathi
Dhiraj
D
Department of Hepatology, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK. tdrdhir@aol.com
Ferguson
James
J
Barkell
Holly
H
Macbeth
Kim
K
Ireland
Hamish
H
Redhead
Doris N
DN
Hayes
Peter C
PC
D016022:Case-Control Studies; D020099:Coated Materials, Biocompatible; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D006975:Hypertension, Portal / Q000000981:diagnostic imaging / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000295:instrumentation / Q000379:methods*; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011859:Radiography; D012008:Recurrence; D012044:Regression Analysis; D012086:Reoperation; D015607:Stents; D016896:Treatment Outcome; D014463:Ultrasonography
D020099:Coated Materials, Biocompatible; D011138:Polytetrafluoroethylene