title: Construction of Transjugular Intrahepatic Portosystemic Shunt: Bare Metal Stent/Stent-graft Combination versus Single Stent-graft, a Prospective Randomized Controlled Study with Long-term Patency and Clinical Analysis.
abstract: BACKGROUND
  Balanced adjustment of the portal vein shunt volume during a transjugular intrahepatic portosystemic shunt (TIPS) is critical for maintaining liver perfusion and decreasing the incidence of liver insufficiency. A stent-graft is proved to be superior to a bare metal stent (BMS) for the construction of a TIPS. However, the clinical results of the combination application of stents and stent-grafts have not been determined. This study aimed to compare the technique of using a combination of stents and stent-grafts with using a single stent-graft to construct a TIPS.
  
  
  METHODS
  From April 2011 to November 2014, a total of fifty patients were randomly assigned to a stents-combination group (Group I, n = 28) or a stent-graft group (Group II, n = 22). Primary patency rates were calculated. Clinical data, including the technical success rate, bleeding control results, incidence of encephalopathy, liver function preservation, and survival rate, were assessed.
  
  
  RESULTS
  Technically, the success rate was 100% for both groups. The primary patency rates at 1, 2, and 3 years for Group I were 96%, 84%, and 77%, respectively; for Group II, they were 90%, 90%, and 78%, respectively. The survival rates at 1, 2, and 3 years for Group I were 79%, 74%, and 68%, respectively; for Group II, they were 82%, 82%, and 74%, respectively. The incidence of hepatic encephalopathy was 14.3% for Group I and 13.6% for Group II. The Child-Pugh score in Group I was stable at the end of the follow-up but had significantly increased in Group II (t = -2.474, P = 0.022).
  
  
  CONCLUSIONS
  The construction of a TIPS with either the single stent-graft or BMS/stent-graft combination is effective for controlling variceal bleeding. The BMS/stent-graft combination technique is superior to the stent-graft technique in terms of hepatic function preservation indicated by the Child-Pugh score. However, considering the clinical results of the TIPS, the two techniques are comparable in their primary shunt patency, incidence of encephalopathy and patient survival during the long-term follow-up.
authors.affiliation: Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Chang-Ming
authors.initials: CM
authors.lastname: Wang
authors.affiliation: Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Xuan
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Fu
authors.affiliation: Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Jing-Yuan
authors.initials: JY
authors.lastname: Luan
authors.affiliation: Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Tian-Run
authors.initials: TR
authors.lastname: Li
authors.affiliation: Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Zhao
authors.affiliation: Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Guo-Xiang
authors.initials: GX
authors.lastname: Dong
mesh_terms: D000368:Aged; D005260:Female; D006501:Hepatic Encephalopathy / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011169:Portal Vein / Q000601:surgery; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications; D011446:Prospective Studies; D015607:Stents; D016896:Treatment Outcome
chemical_list: D011138:Polytetrafluoroethylene