J Korean Soc Radiol.  2013 Aug;69(2):113-121. 10.3348/jksr.2013.69.2.113.

Comparison of Shunt Patency and Clinical Outcomes between Bare Stents and Expanded Polytetrafluoroethylene-Covered Stents for Transjugular Intrahepatic Portosystemic Shunts

Affiliations
  • 1Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea. stent@paran.com
  • 2Department of Nursing, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea.

Abstract

PURPOSE
The purpose of this study is to compare shunt patency and clinical outcomes between bare stents and expanded polytetrafluoroethylene (ePTFE) covered stents in patients who had undergone transjugular intrahepatic portosystemic shunt (TIPS) creation.
MATERIALS AND METHODS
43 consecutive patients with active gastroesophageal variceal bleeding who had undergone de novo TIPS creation were included in this study. For TIPS creation, bare stents were placed in twenty patients (Group 1) from January 2001 to December 2003, while ePTFE-covered stents were placed in twenty-three patients (Group 2) from January 2004 to December 2007. The primary and secondary patency rates of TIPS along with the clinical outcome were assessed, and a comparison was made between the two groups.
RESULTS
The technical success rate was 100%. Cumulative primary shunt patency rate in Group 1 was 78.5%, 55.8%, and 45.8% at 6, 12, and 24 months, respectively, and in Group 2, 91.1%, 86.0%, and 79.9%, respectively (p = 0.009). Cumulative secondary shunt patency rate in Group 1 was 86.3%, 70.7%, and 64.3%, respectively, and in Group 2, 91.1%, 91.1%, and 85.0%, respectively (p = 0.022).
CONCLUSION
The use of ePTFE-covered stents particularly designed to spare the juxtacaval segment of the hepatic vein resulted in an improved patency of shunts compared to using bare stents.


MeSH Terms

Hemorrhage
Hepatic Veins
Humans
Polytetrafluoroethylene
Portasystemic Shunt, Surgical
Stents
Varicose Veins
Polytetrafluoroethylene

Figure

  • Fig. 1 The Niti-S® Covered Stent: the stent consists of a covered middle portion that is 3 to 4 centimeters long and bare segments on both ends each measuring 2 centimeters in length. The diameter of the stent is 10 mm. Gold markers indicated the transition between the covered and bare segments.

  • Fig. 2 The schematic cross section of the Niti-S® Covered Stent: the outer polyurethane layer attaches the expanded polytetrafluoroethylene graft to the stent wires (0.007 in diameter).

  • Fig. 3 TIPS procedure and stent placement. A 59-year-old man with hepatitis B cirrhosis and variceal bleeding. A. The direct splenoportogram shows large gasric varices. B. Tract dilatation was performed using an angioplasty balloon catheter (6 mm in diameter, 4 cm in length). The waists in the balloon indicate the location of the hepatic vein (solid arrow) and the portal vein (empty arrow), while the tract is located between the two. C. The radiograph shows the covered stent that has been placed along the shunt. The transition between the covered and bare segments of the stent can be identified by the gold markers on both proximal and distal portions of the stent (solid arrows). D. The splenoportogram acquired after stent placement shows that the hepatic end of the stent has been placed about 2 cm away from the hepatocaval junction (double arrow). Coil embolization of the varices was additionally performed after the TIPS procedure due to insufficient decompression of the varices (solid arrow). Note.-TIPS = transjugular intrahepatic portosystemic shunt

  • Fig. 4 Time-to-event analysis of TIPS primary patency: primary patency of the covered stent (91.1% at 6 m, 86.0% at 1 y, and 79.9% at 2 y) was superior to that of the bare stent (78.5% at 6 m, 55.8% at 1 y, and 45.8% at 2 y) at all time points (p = 0.009). Note.-TIPS = transjugular intrahepatic portosystemic shunt

  • Fig. 5 Time-to-event analysis of TIPS secondary patency: secondary patency of the covered stent (91.1% at 6 m, 91.1% at 1 y, and 85.0% at 2 y) was superior to that of the bare stent (83.6% at 6 m, 70.7% at 1 y, and 64.3% at 2 y) at all time points (p = 0.022). Note.-TIPS = transjugular intrahepatic portosystemic shunt


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