title: Long-term follow-up of TIPS created with expanded poly-tetrafluoroethylene covered stents.
abstract: BACKGROUND
  Transjugular intrahepatic portosystemic shunts (TIPS) created with expanded poly-tetrafluoroethylene-covered stents have largely replaced bare metal stents. Short-term shunt patency is typically assessed with protocol Doppler ultrasound (US), while little information exists with regard to long-term patency.
  
  
  OBJECTIVE
  We investigated the value of Doppler US in assessing TIPS patency as well as long-term clinical outcomes.
  
  
  METHODS
  A retrospective analysis of 59 patients with covered stents used for TIPS between January 2001 and December 2011 was performed.
  
  
  RESULTS
  Fifty-four patients had early (median 9 days) Doppler US follow-up. Seven of eight patients with an abnormal baseline US required stent revisions. None of the 46 patients with normal baseline Doppler US required revisions within the first 6 months; six of these patients subsequently had a portogram because of symptoms, but all TIPS were patent. Fifty-two patients survived for long-term (>6 months) follow-up, averaging 654 days and three Doppler US exams. Five of six patients with abnormal follow-up Doppler US required revisions, whereas none of the 46 patients with normal follow-up US had revisions. The recurrence of symptoms of portal hypertension and/or hepatic encephalopathy (HE) was low (4/52 patients). No significant predictors of long-term stenosis were identified. Post-TIPS HE was independent of pre-TIPS HE or Child-Pugh score.
  
  
  CONCLUSIONS
  Short-term patency and that at approximately 2 years after TIPS placement was 87 and 77 %, respectively. We conclude that Doppler US at least 1 week after TIPS is warranted, but repeated Doppler US follow-up is probably not necessary in the absence of clinical symptoms.
authors: Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, 2140 Medical District Dr. #4022, Dallas, TX 75235, USA. krishna.sajja@utsouthwestern.edu
authors: Krishna C
authors: KC
authors: Sajja
authors: Bart L
authors: BL
authors: Dolmatch
authors: Don C
authors: DC
authors: Rockey
mesh_terms: D000328:Adult; D004868:Equipment Failure / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000295:instrumentation*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler
chemical_list: D011138:Polytetrafluoroethylene
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