Prognostic Factors for Acute Transjugular Intrahepatic Portosystemic Shunt Occlusion Using Expanded Polytetrafluoroethyl
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ORIGINAL ARTICLE
Prognostic Factors for Acute Transjugular Intrahepatic Portosystemic Shunt Occlusion Using Expanded Polytetrafluoroethylene‑Covered Stent Xiaoze Wang1 · Xuefeng Luo1 · Ming Zhao1 · Jinlei Song1 · Xiao Li2 · Li Yang1 Received: 16 September 2019 / Accepted: 10 December 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Background The expanded polytetrafluoroethylene (ePTFE)-covered stent has been widely used in the transjugular intrahepatic portosystemic shunt (TIPS) procedure. However, the epidemiologic data of acute TIPS occlusion (ATO) and the underlying mechanisms are scarce. Aims The purpose of this study was to evaluate the incidence and prognostic factors for ATO within 1 week in TIPS recipients using ePTFE-covered stents. Methods We identified 222 patients who underwent ePTFE-covered TIPS creation for complications of portal hypertension between June 2015 and June 2017 at a large tertiary center. Medical records and TIPS procedure data were retrospectively reviewed, and the influence of these variables on ATO was assessed by multivariate logistic regression analysis. Results TIPS technical success was achieved in 219 patients (98.6%). Two patients were excluded due to missing data, leaving 217 patients for final analysis. ATO occurred in nine patients (4.1%). Blood flow was restored by balloon angioplasty (n = 4), additional stent insertion (n = 4), and parallel TIPS (n = 1). In multivariable logistic regression, intrastent stenosis (HR 43.871; 95% CI 3.816, 504.373; P = 0.002), previous splenectomy (HR 26.843; 95% CI 2.106, 342.124; P = 0.011), and stent shortening in the hepatic vein (HR 11.54; 95% CI 1.021, 130.416; P = 0.048) were demonstrated as independent significant risk factors for ATO. Conclusions These findings suggest that the intrastent stenosis, previous splenectomy, and stent shortening in the hepatic vein are vital prognostic factors for ATO in TIPS recipients. Individualized post-TIPS management strategy was required. Keywords Liver cirrhosis · Transjugular intrahepatic portosystemic shunt · Acute occlusion · Thrombosis · Splenectomy
Introduction Transjugular intrahepatic portosystemic shunt (TIPS) creation is an established procedure for the treatment of portal hypertension and its complications, such as variceal bleeding and refractory ascites [1]. When bare stents were
used, the reported one-year primary and assisted shunt patency rates were 24–53% and 72–85%, respectively [2, 3]. The introduction of the expanded polytetrafluoroethylene (ePTFE)-covered stent has greatly improved patency, but shunt dysfunction still occurs in 8–20% of patients at 1 year after TIPS creation [4–7].
* Xuefeng Luo [email protected]
Li Yang [email protected]
Xiaoze Wang [email protected]
1
Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu 610041, Sichuan, People’s Republic of China
2
Department of Interventional Therapy, National Cancer Center and Cancer Hospital, Ch
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