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

• DOI: 10.1371/journal.pone.0212658
• Publication Date: 2019-02-27T19:12:06Z
• Authors: Xuefeng Luo; Ming Zhao; Xiaoze Wang; Mingshan Jiang; Jiaze Yu; Xiao Li; Li Yang
• Keywords: Adult; Graft Rejection; Male; Time Factors; Science; Kaplan-Meier Estimate; Esophageal and Gastric Varices; 03 medical and health sciences; 0302 clinical medicine; Hypertension, Portal; Humans; Polytetrafluoroethylene; Vascular Patency; Retrospective Studies; Q; R; Middle Aged; 3. Good health; Treatment Outcome; Hepatic Encephalopathy; Splenectomy; Medicine; Female; Stents; Portasystemic Shunt, Transjugular Intrahepatic; Gastrointestinal Hemorrhage; Research Article; Follow-Up Studies

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.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.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.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.