title: TIPS for refractory ascites: a 6-year single-center experience with expanded polytetrafluoroethylene-covered stent-grafts.
abstract: OBJECTIVE. This single-center study evaluated the use of expanded polytetrafluoroethylene (ePTFE)-covered stent-grafts for transjugular intrahepatic portosystemic shunt (TIPS) placement to manage portal hypertension-related refractory ascites. MATERIALS AND METHODS. One hundred patients at a single tertiary care center in a major metropolitan hospital underwent TIPS placement with an ePTFE-covered stent-graft (Viatorr TIPS Endoprosthesis). Patients with portal hypertension-related ascites and preexisting hepatocellular carcinoma or liver transplant were excluded from the analysis. Records were reviewed for demographic characteristics, technical success of the TIPS procedures, and stent follow-up findings. Clinical results were assessed at 90- and 180-day intervals. RESULTS. Immediate technical success of the TIPS procedure was 100%. Of the 61 patients with documented follow-up, 55 (90.2%) had a partial or complete ascites response to TIPS creation. Of these 55 patients, nine experienced severe encephalopathy. Six of 61 patients (9.8%) did not experience a significant ascites response. Overall survival was 78.7% at 365-day follow-up. The 365-day survival was 84.2% for patients with a model for end-stage liver disease (MELD) score of less than 15, 67.0% for those with a score of 15-18, and 53.8% for those with a score of greater than 18 (p = 0.01). For patients with a MELD score of less than 18, the 365-day survival was 88.0% for those with an albumin value of 3 mg/dL or greater and 72.8% for those with an albumin value of less than 3 mg/dL (p = 0.04). CONCLUSION. TIPS placement using an ePTFE-covered stent-graft is an efficacious therapy for refractory ascites. Patients with preserved liver function-characterized by a MELD score of less than 15 or a MELD score of less than 18 and an albumin value of 3 mg/dL or greater-experience the greatest survival benefit.
authors.affiliation: 1 Department of Radiology, Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, Box 1234, New York, NY 10029.
authors.forename: Zachary L
authors.initials: ZL
authors.lastname: Bercu
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Fischman
authors.forename: Edward
authors.initials: E
authors.lastname: Kim
authors.forename: F Scott
authors.initials: FS
authors.lastname: Nowakowski
authors.forename: Rahul S
authors.initials: RS
authors.lastname: Patel
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Schiano
authors.forename: Charissa Y
authors.initials: CY
authors.lastname: Chang
authors.forename: Robert A
authors.initials: RA
authors.lastname: Lookstein
mesh_terms: D000328:Adult; D000368:Aged; D001201:Ascites / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000295:instrumentation*; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate; D013997:Time Factors; D055815:Young Adult
chemical_list: D011138:Polytetrafluoroethylene
keywords: cirrhosis; expanded polytetrafluoroethylene (ePTFE)–covered stent; portal hypertension; refractory ascites; transjugular intrahepatic portosystemic shunt (TIPS)