Long-term patency and clinical outcome of the transjugular intrahepatic portosystemic shunt using the expanded polytetrafluoroethylene stent-graft

PLoS One. 2019 Feb 27;14(2):e0212658. doi: 10.1371/journal.pone.0212658. eCollection 2019.

Abstract

Background: Transjugular intrahepatic portosystemic shunt (TIPS) creation is an established treatment option to management the complications of portal hypertension. Recent data on the long-term outcomes of TIPS are scarce.

Materials and methods: In this single-institution retrospective study, 495 patients underwent TIPS with the Fluency stent-grafts between December 2011 and June 2015 were evaluated. The cumulative rates of TIPS dysfunction, hepatic encephalopathy (HE), survival, and variceal rebleeding were determined using the Kaplan-Meier method. Cox regression analysis was used to assess the parameters on TIPS patency, occurrence of HE and all-cause mortality.

Results: Technical success was 98.2%. TIPS-related complications occurred in 67 patients (13.5%) during the index hospital stay. TIPS creation resulted in an immediate decrease in mean portosystemic pressure gradient from 23.4 ± 7.1 mmHg to 7.6 ± 3.5 mmHg. The median follow-up period was 649 days. Primary TIPS patency rates were 93%, and 75.9% at 1 and 3 years, respectively. Previous splenectomy was associated with a higher risk of TPS dysfunction. The cumulative survival rates were 93.4% and 77.2% at 1 and 3 years, respectively. The 1- and 3-year probability of remaining free of variceal bleeding rates were 94.2% and 71.4%, respectively.

Conclusions: This retrospective single-center experience with TIPS using the Fluency stent-grafts demonstrates good long-term patency and favorable good clinical results. Previous splenectomy strongly predicts shunt dysfunction.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Esophageal and Gastric Varices / epidemiology
  • Esophageal and Gastric Varices / etiology
  • Esophageal and Gastric Varices / prevention & control
  • Female
  • Follow-Up Studies
  • Gastrointestinal Hemorrhage / epidemiology
  • Gastrointestinal Hemorrhage / etiology
  • Gastrointestinal Hemorrhage / prevention & control
  • Graft Rejection / epidemiology*
  • Graft Rejection / etiology
  • Graft Rejection / physiopathology
  • Hepatic Encephalopathy / epidemiology
  • Hepatic Encephalopathy / etiology
  • Hepatic Encephalopathy / prevention & control
  • Humans
  • Hypertension, Portal / complications
  • Hypertension, Portal / mortality
  • Hypertension, Portal / surgery*
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Polytetrafluoroethylene
  • Portasystemic Shunt, Transjugular Intrahepatic / adverse effects*
  • Portasystemic Shunt, Transjugular Intrahepatic / instrumentation
  • Portasystemic Shunt, Transjugular Intrahepatic / methods
  • Retrospective Studies
  • Splenectomy / adverse effects
  • Stents / adverse effects
  • Time Factors
  • Treatment Outcome
  • Vascular Patency / physiology*

Substances

  • Polytetrafluoroethylene

Grants and funding

This study was funded by the National Natural Science Foundation of China (grant number 81501566). The URL of the funder’s website is http://www.nsfc.gov.cn/. Initials of authors who received the funding: XFL. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.