title: Covered stents are better than uncovered stents for transjugular intrahepatic portosystemic shunts in cirrhotic patients with refractory ascites: a retrospective cohort study.
abstract: OBJECTIVE
  Transjugular intrahepatic portosystemic shunt (TIPS) is an accepted interventional technique to treat refractory ascites in cirrhotic patients with severe portal hypertension. The expanded-polytetrafluoroethylene (e-PTFE) covered stent-graft (cs-TIPS) gives a better shunt patency rate than uncovered stents (ncs-TIPS). Our aim was to retrospectively evaluate whether cs-TIPS indeed improves refractory ascites and overall survival in a more effective way than ncs-TIPS in patients with cirrhosis.
  
  
  METHODS
  From 1992 to 2006, 222 cirrhotic patients with refractory ascites underwent a TIPS-procedure. In 126 patients a ncs-TIPS was inserted, in the remaining 96 patients a csTIPS was inserted. Liver transplantation and/or death were the end points of the follow-up.
  
  
  RESULTS
  The baseline characteristics of both groups were similar: age (55 +/- 11 years, ncs-TIPS/56 +/- 10 years, cs-TIPS), alcoholic cirrhosis (73% ncs-TIPS/80% cs-TIPS), Child-Pugh (9 +/- 2.0 ncs-TIPS/9.2 +/- 1.3 cs-TIPS) and MELD (15 +/- 6 ncs-TIPS/15 +/- 4.9 cs-TIPS), except that the bilirubin level was higher in the cs-TIPS group (2.5 +/- 2.7 mg/dL in cs-TIPS vs. 1.5 +/- 3.6 mg/dL in ncs-TIPS). One year shunt dysfunction occurred in 49% (n=63) of the ncs-TIPS vs. 19% (n = 18) of the cs-TIPS (P < 0.0001) and post TIPS encephalopathy in 56% (n=70) of the ncs-TIPS vs. 22% (n = 22) in the cs-TIPS group. Ascites control and overall survival were better in the cs-TIPS (P = 0.0071). The gain in survival in the cs-TIPS patients occurred especially in patients with a baseline MELD score <16 (P < 0.0001). Post TIPS encephalopathy and ncs-TIPS were independently related with poor survival (P < 0.0001, P = 0.0150; respectively).
  
  
  CONCLUSIONS
  In cirrhotic patients with refractory ascites cs-TIPS offers better symptomatic control of the ascites at one year follow-up and a better overall survival, especially in patients with a MELD score of <16 at baseline.
authors.affiliation: Department of Radiology, University Hospitals Leuven, Belgium. geert.maleux@uzleuven.be
authors.forename: G
authors.initials: G
authors.lastname: Maleux
authors.forename: N A
authors.initials: NA
authors.lastname: Perez-Gutierrez
authors.forename: S
authors.initials: S
authors.lastname: Evrard
authors.forename: A
authors.initials: A
authors.lastname: Mroue
authors.forename: O
authors.initials: O
authors.lastname: Le Moine
authors.forename: W
authors.initials: W
authors.lastname: Laleman
authors.forename: F
authors.initials: F
authors.lastname: Nevens
mesh_terms: D000328:Adult; D000368:Aged; D001201:Ascites / Q000601:surgery; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents
chemical_list: D011138:Polytetrafluoroethylene