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15.09.2016 | Vascular-Interventional

Expanded polytetrafluoroethylene-covered stent-grafts for transjugular intrahepatic portosystemic shunts in cirrhotic patients: Long-term patency and clinical outcome results

verfasst von: Barbara Geeroms, Wim Laleman, Annouschka Laenen, Sam Heye, Chris Verslype, Schalk van der Merwe, Frederik Nevens, Geert Maleux

Erschienen in: European Radiology | Ausgabe 5/2017

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Abstract

Purpose

To retrospectively analyse long-term patency and overall survival of cirrhotic patients treated with TIPSS using e-PTFE-covered stents. Additionally, prognostic factors for better patency and survival were analysed.

Materials and methods

Two hundred and eighty-five consecutive cirrhotic patients with severe portal hypertension-related symptoms were included. Follow-up, including clinical assessment and duplex ultrasound, was analysed up to end of study, patient’s death, liver transplantation or TIPSS-reduction. Patency rates and overall survival were estimated by the Kaplan-Meier method; potential differences in outcome between subgroups were calculated using the Pepe and Mori test.

Results

The 1-, 2- and 5-year primary patencies were 91.5 %, 89.2 % and 86.2 %, respectively, with no new shunt dysfunctions after 5 years’ follow-up. TIPSS revision was performed more often in ascites patients (P = 0.02). The 1-, 4- and 10-year survival rates were 69.2 %, 52.1 % and 30.7 %, respectively. Survival was higher in Child-Pugh class A-B (P = 0.04), in the recurrent bleeding group (P = 0.008) and in patients with underlying alcoholic cirrhosis (P = 0.01).

Conclusion

Long term, primary patency of e-PTFE-covered TIPSS stents remains very high (>80 %); shunt revision was required more frequently in ascites patients. Overall survival was better in Child-Pugh A-B patients with recurrent variceal bleeding and alcoholic liver cirrhosis.

Keypoints

• Long-term primary patency rate of e-PTFE-covered TIPSS stents remains very high.

• No new shunt dysfunction was found after 5 years of follow-up.

• Shunt revision was required more frequently in ascites patients.

• Four and 10 years’ overall survival was 50 and 30 %, respectively.

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Titel: Expanded polytetrafluoroethylene-covered stent-grafts for transjugular intrahepatic portosystemic shunts in cirrhotic patients: Long-term patency and clinical outcome results
verfasst von: Barbara Geeroms
Wim Laleman
Annouschka Laenen
Sam Heye
Chris Verslype
Schalk van der Merwe
Frederik Nevens
Geert Maleux
Publikationsdatum: 15.09.2016
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 5/2017
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-016-4570-5

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Expanded polytetrafluoroethylene-covered stent-grafts for transjugular intrahepatic portosystemic shunts in cirrhotic patients: Long-term patency and clinical outcome results