title: Transjugular Intrahepatic Portosystemic Shunts in Patients with Cirrhosis with Refractory Ascites: Comparison of Clinical Outcomes by Using 8- and 10-mm PTFE-covered Stents.
abstract: Purpose To compare the efficacy and complications of transjugular intrahepatic portosystemic shunt (TIPS) creation performed by using a 10-mm or an 8-mm-diameter polytetrafluoroethylene (PTFE)-covered stent in a consecutive series of patients with cirrhosis with refractory ascites (RA). Materials and Methods The institutional review board approved this retrospective study and informed consent was waived. One hundred seventy-one patients with RA (mean age, 58.7 years ± 10.3; 95% confidence interval [CI]: 57.2 years, 60.3 years) had undergone TIPS placement by using 10-mm (60 patients) or 8-mm (111 patients) covered stent between January 2004 and December 2012. Median follow-up time was 16.8 months (range, 3.4-84.8 months). Hemodynamic changes, incidence of hepatic encephalopathy, and long-term (>3 months) need for paracentesis after TIPS placement were evaluated and calculated by using the Kaplan-Meier method and were compared by using the log-rank test. Results Pre-TIPS demographics and clinical characteristics of the two groups were comparable. The portosystemic gradient before TIPS was 17.0 mm Hg ± 4.2 (95% CI: 15.9 mm Hg, 18.1 mm Hg) in the 10-mm group versus 16.1 mm Hg ± 3.7 (95% CI: 15.4 mm Hg, 16.8 mm Hg) in the 8-mm group (P = .164). After TIPS, the portosystemic gradient was 6.5 mm Hg ± 3.4 (95% CI: 5.7 mm Hg, 7.4 mm Hg) in the 10-mm group versus 7.5 mm Hg ± 2.6 (95% CI: 6.9 mm Hg, 7.9 mm Hg) in the 8-mm group (P = .039). The long-term need for paracentesis was greater in the 8-mm group (64 of 111 patients [58%] vs 18 of 60 patients [31%], P = .003). Overall, hepatic encephalopathy was similar in both groups (45 of 111 patients [41%] vs 26 of 60 patients [44%], P = .728). Conclusion A10-mm PTFE-covered stent leads to better control of RA secondary to portal hypertension in patients with cirrhosis, compared with an 8-mm stent, without increasing the incidence of hepatic encephalopathy.©RSNA, 2017.
authors.affiliation: From the Department of Diagnostic and Therapeutic Services (R.M., L.M., M.D., A.L.), Research Office (F.T.), and Hepatology Unit (I.P.), IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Via Tricomi 5, 90127 Palermo, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Miraglia
authors.affiliation: From the Department of Diagnostic and Therapeutic Services (R.M., L.M., M.D., A.L.), Research Office (F.T.), and Hepatology Unit (I.P.), IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Via Tricomi 5, 90127 Palermo, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Maruzzelli
authors.affiliation: From the Department of Diagnostic and Therapeutic Services (R.M., L.M., M.D., A.L.), Research Office (F.T.), and Hepatology Unit (I.P.), IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Via Tricomi 5, 90127 Palermo, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Tuzzolino
authors.affiliation: From the Department of Diagnostic and Therapeutic Services (R.M., L.M., M.D., A.L.), Research Office (F.T.), and Hepatology Unit (I.P.), IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Via Tricomi 5, 90127 Palermo, Italy.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Petridis
authors.affiliation: From the Department of Diagnostic and Therapeutic Services (R.M., L.M., M.D., A.L.), Research Office (F.T.), and Hepatology Unit (I.P.), IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Via Tricomi 5, 90127 Palermo, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: D'Amico
authors.affiliation: From the Department of Diagnostic and Therapeutic Services (R.M., L.M., M.D., A.L.), Research Office (F.T.), and Hepatology Unit (I.P.), IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Via Tricomi 5, 90127 Palermo, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Luca
mesh_terms: D000328:Adult; D000368:Aged; D001201:Ascites / Q000000981:diagnostic imaging / Q000601:surgery*; D020099:Coated Materials, Biocompatible; D003287:Contrast Media; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
chemical_list: D020099:Coated Materials, Biocompatible; D003287:Contrast Media; D011138:Polytetrafluoroethylene