Comparison study of Doppler ultrasound surveillance of expanded polytetrafluoroethylene-covered stent versus bare stent in transjugular intrahepatic portosystemic shunt.
OBJECTIVE
This prospectively randomized controlled study aimed to assess with Doppler ultrasound (US) the shunt function of expanded polytetrafluoroethylene (ePTFE)-covered transjugular intrahepatic portosystemic shunt (TIPS) stent versus bare stent and to evaluate the usefulness of routine TIPS follow-up of ePTFE-covered stents.


METHODS
Sixty consecutive patients were randomized for bare or covered transjugular TIPS stenting in our institution between April 2007 and April 2009. Data of follow-up Doppler US, angiography, and portosystemic pressure gradient measurements were collected and analyzed.


RESULTS
The follow-up period was 8.34 + or - 4.42 months in the bare-stent group and 6.16 + or - 3.89 months in the covered-stent group. Baseline clinical characteristics were similar in both groups. Two hundred three US studies were performed in 60 patients, with a mean of 3.4 per patient, and demonstrated abnormalities in 28 patients (21 bare stents, 7 ePTFE-covered stents), 19 of them (13 in bare-stent group, 6 in covered-stent group) showing no clinical evidence of recurrence. Ten of 13 patients in the bare-stent group underwent balloon angioplasty or additional stent placement, whereas only one of six patients in the covered-stent group needed reintervention for intimal hyperplasia. The average peak velocity in the midshunt of ePTFE-covered stent was 139 + or - 26 cm/s after TIPS creation and 125 + or - 20 cm/s during follow-up, which was significantly higher than the bare-stent group (p < 0.05). The main portal vein and hepatic artery showed higher flow velocities in the ePTFE-covered stent group than in the bare-stent group. ePTFE-covered stents maintained lower portosystemic pressure gradient than bare stents (9.5 + or - 2.9 versus 13.2 + or - 1.5 mmHg, p < 0.05).


CONCLUSIONS
ePTFE-covered stents resulted in higher patency rates and better hemodynamics than bare stents. Routine US surveillance may not be necessary in patients with ePTFE-covered TIPS stent.
Research Institute of General Surgery, Jinling Hospital, Nanjing, China.
Qian
Q
Huang
Xingjiang
X
Wu
Xinxin
X
Fan
Jianmin
J
Cao
Jianming
J
Han
Lin
L
Xu
Ning
N
Li
D005260:Female; D005500:Follow-Up Studies; D006503:Hepatic Veins / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D008102:Liver Circulation; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011169:Portal Vein / Q000000981:diagnostic imaging* / Q000601:surgery; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000295:instrumentation* / Q000379:methods; D011446:Prospective Studies; D011474:Prosthesis Design; D015607:Stents; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler / Q000379:methods*; D014654:Vascular Patency
D011138:Polytetrafluoroethylene