title: [Effect of covered stent length in portal and hepatic veins on long-term clinical efficacy of transjugular intrahepatic portosystemic shunt].
abstract: OBJECTIVE
  To evaluate the effect of the length of covered stents in the portal and hepatic veins on long-term clinical efficacy of transjugular intrahepatic portosystemic shunt (TIPS).
  
  
  METHODS
  We retrospectively reviewed 53 cases receiving TIPSs between January, 2008 and December, 2011. All the shunts were created with Fluency stents (8 mm in diameter). Bare metal grafts of the same diameter were implanted to extend the length in the portal and hepatic veins as deemed necessary according to angiographic images. The primary patency, hepatic encephalopathy and patient survival were evaluated during the follow up. The length of the covered stents within the hepatic vein (X1) and in the portal vein (X2), and the total length of stents placed in the hepatic vein (X3) and the portal vein (X4) were measured and their effects on primary patency and the patients'outcomes were evaluated.
  
  
  RESULTS
  The procedures were completed successfully in all the patients and the mean portosystemic pressure decreased from 29.80∓4.83 mmHg to 19.00∓3.92 mmHg (t=13.44, P<0.01) after the procedure. The patients were followed up for a median of 64 months (3 to 89 months, 39 months on average). Hepatic encephalopathy occurred in 23% (12/53) of the patients after TIPS. Shunt dysfunction occurred in 16 cases, and the cumulative primary patency rates at 1 to 5 years were 83%, 75%, 63%, 62%, and 54%, respectively. The cumulative survival rates of the patients at 1 to 5 years were 79%, 72%, 72%, 69%, and 69%, respectively. Cox proportional regression analysis showed a significant association between the length of covered-stent in the hepatic vein and the primary patency (OR=0.42, P<0.01), and there was a significant association between the length of stent in the portal vein and the patient survival. No significant correlation was found between these parameters and hepatic encephalopathy.
  
  
  CONCLUSIONS
  Increasing the length of the covered stent in the hepatic vein and decreasing the stent length in the portal vein can improve the primary patency and the patient survival receiving TIPS.
authors: Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China. E-mail: 740371580@qq.com.
authors: Peng
authors: P
authors: Hu
authors: Si-Liang
authors: SL
authors: Chen
authors: Zhi-Peng
authors: ZP
authors: Lin
authors: Jian-Bo
authors: JB
authors: Zhao
authors: Yong
authors: Y
authors: Chen
authors: Xiao-Feng
authors: XF
authors: He
authors: Qing-le
authors: QL
authors: Zeng
authors: Yan-Hao
authors: YH
authors: Li
mesh_terms: D000792:Angiography; D006501:Hepatic Encephalopathy; D006503:Hepatic Veins / Q000601:surgery*; D006801:Humans; D011169:Portal Vein / Q000601:surgery*; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome