The impact of secondary insertion of ePTFE-coated stent on sustainable TIPS patency
Authors:
V. Jirkovský 1; T. Fejfar 1; V. Šafka 1; P. Hůlek 1; V. Chovanec 2; A. Krajina 2; J. Raupach 2; M. Lojík 2
Authors‘ workplace:
II. interní klinika Lékařské fakulty UK a FN Hradec Králové, přednosta prof. MUDr. Jaroslav Malý, CSc.
1; Radiologická klinika Lékařské fakulty UK a FN, Hradec Králové, přednosta prof. MUDr. Pavel Eliáš, CSc.
2
Published in:
Vnitř Lék 2007; 53(2): 123-128
Category:
Original Contributions
Overview
Objective:
Retrospective evaluation of the effect of secondary insertion of ePTFE-coated stent in the treatment of TIPS dysfunction versus other current options (simple angioplasty, insertion of additional non-coated stent).
Patient set and methodology:
From the beginning of 2000 to the end of 2004, there were 121 interventions for TIPS dysfunction performed in our centre in which a non-coated stent was used to make up the shunt at the time of intervention. Depending on the type of intervention, the patient set was divided in 4 groups: simple angioplasty (52 cases, 43 %), insertion of non-coated stent (35 cases, 28.9 %), insertion of non-dedicated ePTFE-coated stent (15 cases, 12.4%), and insertion of dedicated ePTFE-coated stent (19 cases, 15.7%). All patients were monitored on a regular basis after the intervention for shunt patency with the use of clinical examination and Doppler ultrasonography, or also portal venography. Primary shunt patency after the intervention was evaluated in all four groups by Kaplan-Meier analysis. The primary shunt patency results after the intervention were compared with the use Cox F text and logrank test.
Results:
The intervention was successful in 120 cases (the overall technical success rate of all interventions was 99.2%). The primary shunt patency was 49.7 % after 12 months and 25.3 % after 24 months following sole angioplasty intervention; 74.9 % after 12 and 64.9 % after 24 months following intervention involving the insertion of non-coated stent; 75.2 % after 12 months and 64.5 % after 24 months following intervention involving the insertion of non-dedicated ePTFE-coated stent, and 88.1 % after 12 months and 80.8 % after 24 months following intervention involving the insertion of a dedicated ePTFE-coated stent. A statistically significant improvement in shunt patency was obtained in the group of interventions involving the insertion of dedicated ePTFE-coated stent and in the group of interventions involving the insertion of non-coated stent as compared with the group of interventions involving sole angioplasty (p < 0.01). Conclusion: From among all the currently used methods of therapeutic intervention for TIPS dysfunction, the best, the best subsequent TIPS patency was obtained after intervention involving insertion of dedicated ePTFE-coated stent.
Key words:
TIPS – portal hypertension therapy – stentgraft
Sources
1. Hůlek P, Vaňásek T, Lata J et al. Vývoj v léčbě portální hypertenze. Folia Gastroenterol Hepatol 2005; 3(Suppl 1): S32-S39.
2. Haskal ZJ, Pentecost MJ, Soulen MC et al. Transjugular Intrahepatic Portosystemic Shunt Stenosis and Revision: Early and Midterm Results. AJR 1994; 163: 439-444.
3.Narazian GK, Ferral H, Castaneda-Zunica WR et al. Development of Stenoses in Transjugular Intrahepatic Portosystemic Shunts. Radiology 1994; 192: 231-234.
4. Sterling KM, Darcy MD. Stenosis of Transjugular Intrahepatic Portosystemic Shunts: Presentation and Management. ARJ 1997; 168: 239-244.
5. Hausegger KA, Karnel F, Georgieva B et al. Transjugular Intrahepatic Portosystemic Shunt Creation with the Viatorr Expanded Polytetrafluoroethylene-Covered Stent-Graft. J Vasc Interv Radiol 2004; 15: 239-248.
6. Bureau C, Garcia-Pagan JC, Otal P et al. Improved Clinical Outcome Using Polytetrafluoroethylene-Coated Stents for TIPS: Results of a Randomized Study. Gastroenterology 2004; 126: 469-475.
7. Charon JPM, Alaeddin FH, Pimpalwar SA et al. Results of a Retrospective Multicenter Trial of the Viatorr Expanded Polytetrafluoroethylene-Covered Stent-Grafts for Transjugular Intrahepatic Portosystemic Shunt Creation. J Vasc Interv Radiol 2004; 15: 1219-1230.
8. Rossi P, Salvatori FM, Fanelli F et al. Polytetrafluoroethylene-Covered Nitinol Stent-Graft for Transjugular Intrahepatic Portosystemic Shunt Creation: 3-year Experience. Radiology 2004; 231: 820-830.
9. Cohen GS, Young HY, Ball DS. Stent-graft as Treatment for TIPS-biliary Fistula. J Vasc Interv Radiol 1996; 7: 665-668.
10. Saxon RR, Timmermans HA, Uchida BT et al. Stent-grafts for Revision of TIPS Stenoses and Occlusions: A Clinical Pilot Study. J Vasc Interv Radiol 1997; 8: 539-548.
11. DiSalle RS, Dolmach BL. Treatment of TIPS stenosis with ePTFE Graft-covered Stents. Cardiovasc Intervent Radiol 1998; 21: 172-175.
12. Sze DY, Vestring T, Liddell RP et al. Recurrent TIPS Failure Associated with Biliary Fistulae: Treatment with PTFE-covered Stenos. Cardiovasc Intervent Radiol 1999; 22: 298-304.
13. Haskal ZJ. Improved Patenty of Transjugular Intrahepatic Portosystemic Shunts in Humans: Creation and Revision with PTFE Stentgrafts. Radiology 1999; 213: 759-766.
14. Haskal ZJ, Weintraub JL, Susman, J. Recurrent. TIPS Thrombosis After Polyethylene Stent-grafts Use and Salvage with Polytetrafluoroethylene Stent-grafts. J Vasc Interv Radiol 2002; 13: 1255-1259.
15. Cejna M, Peck-Radosavljevic M, Thurnher S et al. ePTFE-Covered Stent-Grafts for Revision of Obstructed Transjugular Intrahepatic Portosystemic Shunt. Cardiovasc Intervent Radiol 2002; 25: 365-372.
16. Echenagusia M, Rodriguez-Rosales G, Simo G et al. Expanded PTFE-Covered Stent-Grafts in the Treatment of Transjugular Intrahepatic Portosystemic Shunt (TIPS) Stenoses and Occlusions. Abdom Imaging 2005; 30: 750-754.
17. Ducoin H, El-Khoury J, Rousseau H et al. Histopathologic Analysis of Transjugular Intrahepatic Portosystemic Shunts. Hepatology 1997; 25: 1064-1069.
18. Krajina A, Hulek P, Lojik M et al. Creation of TIPS with The Use of ePTFE Stent-graft (Abstract). Cardiovasc Intervent Radiol 1999; 22(Suppl 2): S122.
19. Andrews RT, Saxon RR, Bloch RD. Stent-grafts for De Novo TIPS: Technique and Early Results. J Vasc Interv Radiol 1999; 10: 1371-1378.
20. Saxon RR, Ross PL, Mendel-Hartving J et al. Transjugular Intrahepatic Portosystemic Shunt Patenty and The Importace of Stenosis Location in The Development of Recurrent Symptoms. Radiology 1998; 207: 683-693.
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