Transjugular intrahepatic portosystemic shunt patency and clinical outcome in patients with Budd-Chiari syndrome: covered versus uncovered stents.
OBJECTIVE
To retrospectively compare primary patency and reintervention rates, clinical outcome, and improvement in hepatic dysfunction (Child-Pugh score) in patients with Budd-Chiari syndrome treated with transjugular intrahepatic portosystemic shunt (TIPS) using bare stents or expanded polytetrafluoroethylene (PTFE)-covered stents.


METHODS
Approval of study and treatment protocol and waiver of informed consent for the retrospective study were obtained from institutional review board. Informed consent was obtained from each patient before procedure. Four male and nine female consecutive patients (mean age, 35.7 years) with Budd-Chiari syndrome treated with TIPS from January 1994 to November 2003 were included. In six patients, TIPS creation was performed with bare stents (group A). After April 2001, TIPS creation was performed in seven patients with expanded PTFE-covered stent-grafts (group B). Follow-up (group A mean, 22.7 months +/- 10.53 [standard deviation]; group B mean, 23.1 months +/- 7.81) was performed at 7 days, 30 days, and 3 months and subsequently every 3 months. Liver function was evaluated every 3 months. Primary end points were 6- and 12-month TIPS patency rates. Secondary end points were reintervention rate and clinical outcome. Patency rates were estimated (Kaplan-Meier method) and compared (log-rank test). Continuous (Mann-Whitney U test) and categoric (chi(2) test) data were compared. Significant differences before and after treatment were determined (Wilcoxon test).


RESULTS
Mean primary patency duration was 4.46 months +/- 3.40 in group A and 22.29 months +/- 8.15 in group B. In group B, a significant increase in primary patency rate (100% and 85.7% vs 16.7% and 0% at 6 and 12 months; P < .001, log-rank test) and a decrease in reintervention rate (0.29 +/- 0.49 vs 6.17 +/- 1.72, P < .001) were observed. Both groups had a significantly decreased Child-Pugh score; group B had a more persistent and significantly higher reduction.


CONCLUSIONS
Expanded PTFE-covered stent-grafts significantly increased primary patency rate of TIPS in patients with Budd-Chiari syndrome, with reduced reintervention rate and prolonged clinical improvement.
Gandini
Roberto
R
Department of Diagnostic Imaging and Interventional Radiology, University of Tor Vergata, Viale Oxford 81, 00133 Rome, Italy.
Konda
Daniel
D
Simonetti
Giovanni
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D006502:Budd-Chiari Syndrome / Q000601:surgery*; D005260:Female; D005465:Fluorocarbon Polymers; D005500:Follow-Up Studies; D006801:Humans; D007601:Jugular Veins; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011170:Portasystemic Shunt, Surgical / Q000379:methods*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D014654:Vascular Patency
D005465:Fluorocarbon Polymers; C010946:polytetrafluoroethane