Comparison of transjugular intrahepatic portosystemic shunt dysfunction in PTFE-covered stent-grafts versus bare stents.

PURPOSE: The aim was to compare the clinical and hemodynamic outcome between polytetrafluoroethylene (PTFE)-coated stent-grafts and bare stents in patients who required both elective and emergency transjugular intrahepatic portosystemic shunt (TIPS) placement due to portal hypertension related complications.

MATERIALS AND

METHODS

Retrospective analysis of all seventy patients with portal hypertension related complications who required TIPS placement in a referral hospital from September 1998 to May 2002 was done. Follow-up was extended until May 2003. PTFE-covered stent-grafts were used in the latter 20. Demographic variables, cirrhosis etiology and Child-Pugh class, indication of TIPS placement and clinical outcome were recorded. The following TIPS-related outcomes were registered: recurrent variceal bleeding and/or ascites, hepatic encephalopathy and mortality.

RESULTS

Baseline characteristics, portacaval gradient (PCG) after TIPS placement and at 1 month angiographic revision were similar in both groups. At 6 month follow-up, PCG was significantly lower in patients with stent-grafts (14.2 mmHg (5.6 mmHg) versus 7 mmHg (1 mmHg), p<0.001). Overall, there were no cases of clinically relevant TIPS dysfunction in the coated stent group while 22% of patients in the bare stent group had recurrence of portal hypertension related complications (p=0.085). Actuarial probability of TIPS dysfunction in bare stents was 82% at 12 months compared to no episode in covered stent-grafts (p=0.03). Mean increase in total serum bilirubin was higher in the PTFE-coated stent group (6.7 mg/dl (14.4 mg/dl) versus 0.5 mg/dl (2.4 mg/dl), p=0.01) without differences in encephalopathy nor mortality rate.

CONCLUSION

One year shunt patency rate is improved with placement of ePTFE-covered stent-grafts without a higher rate of encephalopathy. Further prospective trials are required.