title: Long-Term Patency and Clinical Analysis of Expanded Polytetrafluoroethylene-Covered Transjugular Intrahepatic Portosystemic Shunt Stent Grafts.
abstract: OBJECTIVE
  To evaluate long-term patency and symptomatic recurrence rates following transjugular intrahepatic portosystemic shunt (TIPS) creation with expanded polytetrafluoroethylene (ePTFE)-covered stent grafts and to determine the necessity of extended clinical follow-up beyond 2 years after TIPS creation.
  
  
  METHODS
  A retrospective review including 262 TIPSs created with ePTFE-covered stent grafts between July 2002 and October 2012 was performed. Primary, primary assisted, and secondary patency rates were calculated. Assessment of clinical data included technical, hemodynamic, and clinical success rates, as well as mortality after TIPS creation.
  
  
  RESULTS
  Primary patency rates at 2, 4, and 6 years were 74%, 62%, and 50%, respectively. Primary assisted patency rates at 2, 4, and 6 years were 93%, 85%, and 78%, respectively. Secondary patency rates at 2, 4, and 6 years were 99%, 91%, and 84%, respectively. Technical and hemodynamic success rates were 99% and 93%, respectively. Clinical success rates for refractory ascites were 66% (complete response) and 90% (partial response); clinical success rate for bleeding/varices was 90%. Mortality rates at 2, 4, and 6 years after TIPS creation were 27%, 38%, and 46%, respectively. At the median wait time until transplantation, patients had an 84% chance of being alive. TIPS dysfunction developed in 21% of patients; 30% of revisions occurred later than 2 years during follow-up.
  
  
  CONCLUSIONS
  Beyond 2 years after TIPS creation, patency rates gradually decrease, mortality rates continue to increase, and the chance of recurrent ascites or bleeding remains present. Together, these findings suggest that continued clinical follow-up beyond 2 years is necessary in patients with a TIPS created with an ePTFE-covered stent graft.
authors.affiliation: Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.. Electronic address: cnweber49@gmail.com.
authors.forename: Charles N
authors.initials: CN
authors.lastname: Weber
authors.affiliation: Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Nadolski
authors.affiliation: Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Sarah B
authors.initials: SB
authors.lastname: White
authors.affiliation: Department of Radiology, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania.
authors.forename: Timothy W I
authors.initials: TW
authors.lastname: Clark
authors.affiliation: Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Jeffrey I
authors.initials: JI
authors.lastname: Mondschein
authors.affiliation: Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: S William
authors.initials: SW
authors.lastname: Stavropoulos
authors.affiliation: Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Shlansky-Goldberg
authors.affiliation: Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Scott O
authors.initials: SO
authors.lastname: Trerotola
authors.affiliation: Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Soulen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D020099:Coated Materials, Biocompatible / Q000737:chemistry; D018572:Disease-Free Survival; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis / Q000401:mortality*; D006085:Graft Survival; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene / Q000737:chemistry*; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000401:mortality* / Q000706:statistics & numerical data; D011474:Prosthesis Design; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States; D014654:Vascular Patency; D055815:Young Adult
chemical_list: D020099:Coated Materials, Biocompatible; D011138:Polytetrafluoroethylene