Patency of stents covered with polytetrafluoroethylene in patients treated by transjugular intrahepatic portosystemic shunts: long-term results of a randomized multicentre study.
An 80% dysfunction rate at 2 years limits the use of transjugular intrahepatic portosystemic shunts (TIPS) in the treatment of complications of portal hypertension. The use of covered stents could improve shunt patency; however, long-term effect and safety remain unknown. Eighty patients randomized to be treated by TIPS either with a covered stent (Group 1) or an uncovered prosthesis (Group 2) were followed-up for 2 years. Doppler US was performed every 3 months. Angiography and portosystemic pressure gradient measurement were performed every 6 months or whenever dysfunction was suspected. Actuarial rates of primary patency in Groups 1 and 2 were 76% and 36% respectively (P=0.001). Clinical relapse occurred in four patients (10%) in Group 1 and 12 (29%) in Group 2 (P<0.05). Actuarial rates of being free of encephalopathy were 67% in Group 1 and 51% in Group 2 (P<0.05). Probability of survival was 58% and 45% at 2 years, respectively, in Groups 1 and 2 (NS). The mean Child-Pugh score improved only in Group 1 (from 8.1+/-1.6 to 7+/-2.2 at 2 years -P<0.05). We also compared the Doppler-US parameters between patent and dysfunctioning shunts. In patent shunts, the mean velocity within the portal vein was significantly higher but the performance of Doppler-US was not accurate enough to predict shunt dysfunction. In conclusion, the improvement in TIPS patency by using covered prostheses is maintained over time with a decreased risk of encephalopathy, while the risk of death was not increased.
Bureau
Christophe
C
Federation Digestive Purpan, Service Hepato-Gastro-Enterologie CHU Toulouse, Toulouse, France. bureau.c@chu-toulouse.fr
Garcia Pagan
Juan Carlos
JC
Layrargues
Gilles Pomier
GP
Metivier
Sophie
S
Bellot
Pablo
P
Perreault
Pierre
P
Otal
Philippe
P
Abraldes
Juan-G
JG
Peron
Jean Marie
JM
Rousseau
Hervé
H
Bosch
Jaume
J
Vinel
Jean Pierre
JP
D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006501:Hepatic Encephalopathy / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D053208:Kaplan-Meier Estimate; D008102:Liver Circulation; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011138:Polytetrafluoroethylene; D017082:Portal Pressure; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000503:physiopathology; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects / Q000295:instrumentation*; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012008:Recurrence; D018570:Risk Assessment; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency
D011138:Polytetrafluoroethylene