Viatorr支架与双支架技术行经颈静脉肝内门体分流术的临床疗效观察

目的观察Viatorr支架与双支架技术行经颈静脉肝内门体分流术(TIPS)的临床疗效。方法收集2015年5月-2016年12月于安徽医科大学第一附属医院介入放射科行TIPS治疗的62例门静脉高压患者临床资料,主要表现为上消化道出血55例和顽固性腹水7例。根据术中应用覆膜支架类型分为Viatorr支架组(n=22)和双支架组(裸支架+Fluency覆膜支架,n=40)。术后随访6~17个月,观察分流道通畅率、肝性脑病发生率及病死率。计量资料2组间比较采用独立样本t检验,组内比较采用配对样本t检验;计数资料2组间比较采用χ~2检验。结果 62例患者TIPS手术均成功,共置入Viatorr支架22枚,裸支架40枚,Fluency覆膜支架40枚,直径均为8 mm。Viatorr支架组和双支架组门静脉压力分别由术前(28.7±4.9)mm Hg和(27.2±4.3)mm Hg降至(18.7±4.7)mm Hg和(18.8±3.9)mm Hg,差异均有统计学意义(t值分别为9.9、13.5,P值均<0.01)。55例消化道出血患者术后均停止出血,7例顽固性腹水患者腹水消退。Viatorr支架组和双支架组通畅率分别为95.5%、90.0%,肝性脑病发生率分别为9%、15%,随访期间病死率分别为4.5%和12.5%,差异均无统计学意义(P值均>0.05)。结论采用Viatorr支架或双支架技术行TIPS疗效确切,但采用Viatorr建立TIPS分流道近期疗效与双支架技术无明显差别,其较双支架技术的优势需进一步探究。     

TIPS术中运用Viatorr支架与模拟Viatorr支架的回顾性研究

目的观察Viatorr支架与模拟Viatorr支架行经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt, TIPS)的临床效果。方法收集遂宁市中心医院2017年7月至2018年2月行TIPS治疗的41例食管胃底静脉曲张破裂出血(esophagogatric variceal bleeding, EGVB)及难治性腹水患者的临床资料,按其术中使用支架类型分为Viatorr支架组(n=14)和模拟Viatorr支架组(Fluency覆膜支架与裸支架联合,n=27)。记录手术用时,术后随访1年,观察相关疗效、并发症指标。计量资料比较采用t检验,计数资料比较采用χ~2检验或Fisher确切概率法,两分类变量间关系采用双变量关联性分析。结果两组患者手术操作均成功。34例EGVB患者出血停止,止血率均为100%,7例难治性腹水患者6例腹水有缓解。两组术后门静脉压力较术前均降低,Viatorr支架组较模拟Viatorr支架组下降明显,差异有统计学意义(P0.05)。手术用时分别为(99.4±9.7)min、(109.2±8.6)min;失效率分别为0、29.6%,差异均有统计学意义(P0.05)。Viatorr支架组和模拟Viatorr支架组肝性脑病发生率分别为42.9%、40.7%;肝性脊髓病发生率分别为0、3.7%;病死率分别为7.1%、7.4%,差异无统计学意义(P0.05)。顽固性腹水、肝性脊髓病、肝衰竭与死亡的双变量关联性分析差异有统计学意义(P0.01)。结论 TIPS术中运用Viatorr支架较模拟Viatorr支架门静脉压力下降明显,手术用时及分流道失效率低;在止血效果、肝性脑病与肝性脊髓病发生率及病死率方面差异无统计学意义。顽固性腹水、肝性脊髓病、肝衰竭是TIPS术后死亡的危险因素。     

Viatorr覆膜支架用于TIPS术治疗肝硬化门静脉高压症患者预后研究

目的 研究Viatorr覆膜支架用于经颈静脉肝内门体静脉分流术(TIPS)治疗肝硬化门静脉高压症患者的疗效和转归。方法 2018年1月～2020年1月我院收治的肝硬化并发门静脉高压症患者146例,采用随机数字表法将患者分为对照组73例和观察组73例,在接受TIPS术治疗时分别使用裸支架联合Fluency覆膜支架或Viatorr覆膜支架。随访12 m。结果 观察组手术时间为(99.5±9.8)min,显著短于对照组【(110.0±8.5)min,P＜0.05】,术后两组门静脉压力均显著降低,但差异无统计学意义(P＞0.05);在术后3 m,两组肝功能指标变化无显著性差异(P>0.05);随访12 m,观察组分流道失效率为1.4%,显著低于对照组的23.3%(P＜0.05);观察组死亡5例(6.8%),对照组死亡6例(8.2%,Log-rank值=0.099,P=0.753)。结论 相对于裸支架和Fluency覆膜双支架,使用Viatorr覆膜支架行TIPS术治疗肝硬化并发门脉高压症患者能有效缩短手术时间,保持分流道通畅,值得进一步观察。     

Viatorr覆膜支架在经颈静脉肝内门体分流术中的应用现状

经颈静脉肝内门体分流术(TIPS)已广泛应用于治疗门静脉高压并发症,近年来随着对于TIPS认识程度的加深,覆膜支架得到更进一步的发展应用,其中TIPS专用支架(Viatorr覆膜支架)更是成为关注的焦点。综述了Viatorr覆膜支架的应用与效果,指出采用Viatorr覆膜支架建立肝内分流通道能够明显提高分流道通畅率,在未增加肝性脑病的发生率的同时减少了重复干预及再出血的风险,使患者的生活质量得到提高。     

肝硬化门静脉高压患者行经颈静脉肝内门体分流术术中置入Viatorr支架分流门静脉左、右支血流对疗效的影响

目的探讨在经颈静脉肝内门体分流术(TIPS)术中置入Viatorr支架分流门静脉左支或右支血流对肝硬化门静脉高压患者疗效的影响。方法回顾性分析中国人民解放军西部战区总医院2016年3月-2019年12月接受TIPS治疗的肝硬化门静脉高压症120例患者的临床资料,根据术中造影判断穿刺门静脉靶点位置,将患者分为门静脉左支分流组(n=52)和右支分流组(n=68),分析两组患者术后复发出血、支架功能障碍、肝性脑病发生及生存状况。计量资料2组间比较采用t检验。计数资料2组间比较采用χ2检验。Kaplan-Meier曲线分析再出血率、支架通畅率、肝性脑病发生率及生存率。结果 120例患者手术成功率100%,近期止血率100%。门静脉压力术后较术前明显降低[(9.98±2.84) mm Hg vs (24.72±5.11) mm Hg,t=37.76,P 0.01]。累计再出血率术后12、24个月分别为3.2%、11.0%;肝性脑病累计发生率术后3、6、12、24个月分别为10.8%、13.6%、21.2%、24.5%;随访24个月累计29例肝性恼病患者中,Ⅰ+Ⅱ级23例,Ⅲ级6例;支架功能障碍累计发生率术后12、24个月分别为7.1%、21.4%。累计生存率术后12、24个月分别为92.0%、86.5%。门静脉左支分流组与右支分流组比较,患者术后支架通畅率、再出血率、肝性脑病发生率、生存率比较差异均无统计学意义(P值均 0.05)。结论 TIPS是治疗肝硬化门静脉高压安全、有效的方法;术中置入Viatorr支架,无论建立门静脉左支或右支分流,均不会影响患者的临床疗效。     

TIPS术后分流道闭塞的平行分流

目的探讨建立平行通道治疗经颈静脉肝内门腔静脉分流术(transjugular intrahepatic portosystemic shunt,TIPS)后分流道闭塞的疗效及安全性.方法回顾性分析2012-03/2015-10贵州医科大学附属医院18例TIPS术后分流道完全闭塞的肝硬化患者的临床资料,18例患者均选择建立平行分流道,术后定期随访6-42 mo(平均16.7 mo±10.8 mo).记录所有患者平行分流手术技术成功率,手术持续时间(初次分流及平行分流),平行分流前、后门体静脉压力梯度(portal pressure gradient,PPG),分流道通畅情况等.结果18例患者均成功重建平行分流道;建立平行分流通道手术时间为57.1 min±12.9 min(建立初次分流道手术的平均持续时间为89.2 min±29.4 min,t=4.24,P0.01);平行分流前PPG平均为25.5 mm Hg±7.4 mm Hg(范围,16-37 mm Hg),术后为10.9 mm Hg±2.4 m m H g(范围,7-16 mm Hg),平行分流后PPG明显降低,差异有统计学意义(t=10.1,P0.01);随访阶段4例患者再次出现不同程度的分流道功能障碍,再次分流道造影见3例患者门静脉端狭窄,1例患者肝静脉端狭窄,均经支架及球囊成形后平行分流道恢复通畅.单用覆膜支架、联合运用裸支架及覆膜支架行平行TIPS后1年分流道通畅率分别为70.1%及87.6%.结论建立平行分流通道治疗TIPS后分流道完全闭塞是一种安全、有效的方法.     

采用覆膜支架经颈静脉肝内门体分流对改善术后分流道狭窄及门静脉高压的系统评价

目的 比较采用覆膜支架和裸支架的经颈静脉肝内门体分流术(TIPS)对改善术后分流道狭窄及门静脉高压的临床疗效的影响.方法 检索各大数据库分别采用覆膜支架和裸支架行TIPS后关于临床疗效的对照研究,评价文章质量.运用Revman4.2软件对TIPS分流道狭窄率、门静脉高压相关临床症状复发率和病死率进行分析.结果 共获得1340例相关病例,随机对照研究(12.8%对43.9%,P=0.004)与多项非随机对照试验研究(11.6%对57.6%,P＜0.01)均表明,覆膜支架较裸支架能明显降低TIPS术后1年分流道狭窄率,两类研究报道的覆膜支架组门静脉高压相关症状的复发率也较裸支架组显著降低(7.7%对29.3%,6.4%对14.5%,P＜0.05).结论 覆膜支架在降低TIPS术后分流道狭窄、减少门静脉高压相关临床症状复发方面优于裸支架,这对于改善TIPS术后患者生存时间及质量具有重要意义.     

覆膜支架和裸支架经颈静脉肝内门体分流术的疗效比较

<正>【据《Therap Adv Gastroenterol》2017年1月报道】题:比较覆膜支架和裸支架经颈静脉肝内门体分流术的疗效:一项基于随机对照试验的荟萃分析(作者Qi X等)经颈静脉肝内门体分流术(TIPS)用于治疗肝硬化门静脉高压并发症。自从覆膜支架用于临床后,TIPS分流道通畅得到很大改善。然而,尚不清楚覆膜支架是否可改善患者生存。来自沈阳军区总医院的Qi等通过荟萃分析,比较了覆膜支架和裸支架TIPS患者的预后情况。     

门静脉穿刺造影改良经颈静脉肝内门体分流术治疗门静脉高压上消化道出血

目的探讨经颈静脉肝内门体分流术(TIPS)的改良方法,提高其穿刺准确性和安全性,拓宽TIPS治疗适应证。方法在B超引导下经皮经肝穿刺门静脉右支,成功后引入带金标导管进行门静脉造影、测压、栓塞胃冠状静脉,然后将金标置于门静脉靶穿刺点,引导Rups-100穿刺门静脉,进行门静脉正、侧位造影,确保门静脉穿刺点在距离分叉2 cm以上。有门静脉血栓者用10F鞘管吸出,陈旧血栓用支架旷置。球囊扩张肝实质分流道,置入支架,造影测压。结果20例肝硬化门静脉高压上消化道出血患者用改良TIPS方法治疗均获得成功,上消化道出血即刻得到控制;20例患者共穿刺37针,平均(1.85±0.67) 针;门静脉压力由(30.5±1.1)mm Hg降至(16.9±0.9)mm Hg,治疗前后门静脉压力差异有统计学意义(P<0.05)。4例间接门静脉造影未见显影放弃TIPS治疗的患者,经改良TIPS治疗后也获得成功。20例患者共放置25枚支架,未出现一例与TIPS操作有关的并发症。结论直接门静脉穿刺造影金标定位引导TIPS 操作,可提高TIPS穿刺准确性和安全性,进一步拓宽了TIPS治疗适应证,有利于TIPS技术进一步推广。     

覆膜支架联合长裸支架在TIPS治疗中的应用

目的:评估覆膜支架联合长裸支架在经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt,TIPS)中的应用价值.方法:对南华大学附属南华医院2012-01/2015-01 22例肝硬化食管胃底静脉曲张患者采用覆膜支架联合长裸支架行TIPS治疗.结果:TIPS治疗的技术成功率为100%,术前门静脉压力43.25 cm H2O±4.56 cm H2O(l cm H2O=0.098 k Pa)降至23.78 cm H2O±5.11 c m H2O(t=21.423,P0.01).造影见食管胃底曲张静脉消失,术后患者肝功明显改善,食管胃底静脉曲张程度明显减轻,无急性肝衰竭病例发生.随访6-24 mo,术后6、12、24 m o的累积分流道通畅率分别为95.4%(21/22)、90.9%(20/22)、86.3%(19/22).无"盖帽"情况发生.结论:采用覆膜支架联合长裸支架套叠技术能明显提高分流道的通畅率,为门脉高压症患者的肝内门体分流提供了是一种安全、有效的治疗方法,具有重要的临床应用价值.     

Favorable clinical outcome using a covered stent following transjugular intrahepatic portosystemic shunt in patients with portal hypertension

Aims

To compare retrospectively the clinical outcomes in patients treated with transjugular intrahepatic portosystemic shunt (TIPS) using the novel polytetrafluoroethylene-covered stents (Fluency) and bare stents.

Materials and methods

Sixty consecutive patients with portal hypertension treated with TIPS from April 2007 to April 2009 were included. TIPS creation was performed with Fluency stent grafts in 30 patients (group A) and with bare stents in 30 patients (group B). Liver function, TIPS patency and clinical outcomes were evaluated every 3 months after procedures.

Results

During hospitalization, there were no cases of hepatic encephalopathy (HE) and recurrence of variceal bleedings. Acute shunt occlusion was found in one patient in each group. Follow-ups were performed in group A with average time of 6.16 ± 3.89 months and in group B with 8.34 ± 4.42 months. The rates of recurrent bleeding, shunt occlusion, HE and mortality were 0.03, 0.0, 16.7 and 0% in group A, and 20.0, 30.0, 20.0 and 13.3% in group B, respectively. There was no difference of HE between group A and group B. The decrease of portal pressure and portosystemic pressure gradient, and the increase of portal flow were 34.1 and 23.3%, 60.0 and 52.8%, and 189.5 and 111.1% in group A and B, respectively. There were no differences of liver function between group A and B.

Conclusion

The Fluency stent graft is relatively safe and effective in TIPS creation, with a high patency rate compared with bare stents.     

Selection of a TIPS stent for management of portal hypertension in liver cirrhosis: An evidence-based review

Nowadays,transjugular intrahepatic portosystemic shunt(TIPS)has become a mainstay treatment option for the management of portal hypertension-related complications in liver cirrhosis.Accumulated evidence has shown that its indications are being gradually expanded.Notwithstanding,less attention has been paid for the selection of an appropriate stent during a TIPS procedure.Herein,we attempt to review the current evidence regarding the diameter,type,brand,and position of TIPS stents.Several following recommendations may be considered in the clinical practice:(1)a 10-mm stent may be more effective than an 8-mm stent for the management of portal hypertension,and may be superior to a 12-mm stent for the improvement of survival and shunt patency;(2)covered stents are superior to bare stents for reducing the development of shunt dysfunction;(3)if available,Viatorr stent-grafts may be recommended due to a higher rate of shunt patency;and(4)the placement of a TIPS stent in the left portal vein branch may be more reasonable for decreasingthe development of hepatic encephalopathy.However,given relatively low quality of evidence,prospective well-designed studies should be warranted to further confirm these recommendations.     

经颈静脉肝内门体分流术预防门静脉海绵样变食管胃底静脉曲张再出血的临床应用

目的初步评估经颈静脉肝内门体分流术(TIPS)用于预防门静脉海绵样变(CTPV)患者食管静脉曲张再出血的可行性、有效性和安全性。方法选取2011年1月至2016年12月在山东省立医院住院,诊断为CTPV且合并食管静脉曲张出血史,行TIPS预防再出血的患者67例,纳入回顾性分析并随访。总结技术成功率、并发症发生率、再出血、支架通畅、肝性脑病及生存情况。结果在67例CTPV患者中,56例(83.6%)患者成功行TIPS术。单独通过颈静脉入路15例,经颈静脉联合经皮经肝入路33例,经颈静脉联合经皮经脾入路8例。TIPS术后平均门-体静脉压力梯度,从(28.09±7.28)mmHg降至(17.53±6.12)mmHg(P<0.01)。平均随访(23.91±12.35)个月,累计无出血率87.0%,支架通畅率81.5%,肝性脑性发生率27.8%,累计生存率88.9%。11例未成功行TIPS术的患者中死亡4例,再次出血4例。结论TIPS用于预防门静脉海绵样变性患者食管静脉曲张再出血,是一种安全、可行、有效的方法。     

PTFE-covered stents improve TIPS patency in Budd-Chiari syndrome

Transjugular intrahepatic portosystemic shunt (TIPS) have been shown to be an efficient portal-systemic derivative treatment for Budd-Chiari syndrome (BCS) patients uncontrolled by medical therapy. However, the main drawback of TIPS for this condition is a very high rate of shunt dysfunction. Recently, polytetrafluoroethylene (PTFE)-covered stents have been shown to reduce the incidence of TIPS dysfunction in patients with cirrhosis. The aim of the study was to assess the incidence of TIPS dysfunction in 2 cohorts of BCS patients treated with bare or PTFE-covered stents. The study included 25 TIPS procedures (16 bare stents and 9 covered stents) with a median follow-up period of 20.4 months (range, 3.9-124.8). Fourteen of 16 patients (87%) receiving bare stents had TIPS dysfunction compared to 3 of the 9 patients (33%) receiving PTFE-covered stents (P = .005). The actuarial rates of primary patency in the bare-stent group were 19% at 1 year compared with 67% in the PTFE-covered stent group (P = .02; log-rank test). The number of additional interventional procedures to maintain TIPS patency was significantly greater in the bare-stent than in the PTFE-covered stent group (1.9 +/- 1.2 vs. 0.6 +/- 0.9; P = .007). The number of patients with clinical relapses was greater in the bare-stent group compared to the PTFE-covered stent group (13 vs. 5 episodes in 9 and 3 patients, respectively). In conclusion, PTFE-covered stents have a considerable advantage over bare stents for the TIPS treatment of BCS patients, with a lower dysfunction rate, a lower number of reinterventions, and fewer prosthesis requirements. PTFE-covered stents are preferable in patients with Budd-Chiari Syndrome.     

经颈静脉肝内门体分流术联合胃冠状静脉栓塞术降低曲张静脉再出血率的研究

目的 比较经颈静脉肝内门体分流术(TIPS)及TIPS联合胃冠状静脉栓塞术后的食管胃底静脉曲张再出血率.方法 根据TIPS前1周活动性出血情况,将122例肝硬化食管胃底静脉曲张二级预防再出血患者分别纳入分流组44例,给予TIPS;分流联合断流组78例,给予TIPS联合胃冠状静脉栓塞术.术后随访1年,比较两组的再出血率、支架通畅率及病死率.计量资料用成组设计的t检验,计数资料用Χ2检验,累积曲张静脉再出血率、累积支架通畅率、累积生存率用乘积极限法描述,用Log-rank法进行统计学检验,并将支架通畅率与再出血率及再出血率与生存率做Pearson's相关分析.结果 分流组1年再出血率为41.5%,分流联合断流组为19.5%,两组比较,Χ2=6.320,P=0.012,差异有统计学意义.两组1年支架通畅率及病死率比较,P值均>0.05,差异均无统计学意义.结论 TIPS联合胃冠状静脉栓塞术较单纯TIPS可降低术后1年内的再出血率.

Abstract：

Objective To prospectively compare the rates of gastroesophageal variceal rebleeding in patients underwent TIPS alone and TIPS combined with embolization of gastric coronary veins. Methods According to the bleeding state within one week before the shunt placement, 122 patients with hepatic cirrhosis indicated for the secondary prevention of gastroesophageal variceal rebleeding were allocated to the shunt group (n = 44, treated with TIPS alone) and the shunt plus embolization group (n = 78, treated with TIPS combined with embolization of gastric coronary veins). All the patients were followed up for 1 year, and the 1-year cumulative rates of rebleeding, shunt patency and mortality were compared. Results The basic characteristics of patients in the two groups were comparable (P > 0.05). The 1-year cumulative re-bleeding rates were 41.5% in the shunt group and 19.5% in the shunt combined with embolization group (χ2 = 6.320, P = 0.012). The differences of 1-year cumulative rates of shunt patency and mortality between the two groups were not significant (P > 0.05). Conclusions TIPS combined with embolization of gastric coronary veins could reduce significantly the rate of rebleeding in 1 year after the shunt placement as compared with TIPS alone.     

Patency and clinical outcomes of transjugular intrahepatic portosystemic shunt with polytetrafluoroethylene-covered stents versus bare stents: a meta-analysis

Background and Aim: Transjugular intrahepatic portosystemic shunt (TIPS) with polytetrafluoroethylene‐(PTFE)‐covered stent has been increasingly used for patients with complications of portal hypertension. It is still debated whether the new endoprostheses will improve some clinical outcomes (except for shunt patency) compared to the bare stents. The aims of our meta‐analysis were to explore the patency and clinical outcomes of TIPS with PTFE‐covered stent‐grafts versus bare stents. Methods: Pertinent studies were retrieved through PubMed (1950–2010), MEDLINE (1950–2010), and reference lists of key articles. Outcome measures were primary patency, risk of encephalopathy and survival. Time‐to‐event data analysis was used to calculate the overall hazard ratios (HR). Results: Six studies were identified including a total of 1275 patients (346 TIPS with PTFE‐covered stent‐grafts and 929 TIPS with bare stents). Pooled shunt patency data from four eligible studies suggested a significant improvement of primary patency in patients who were treated with PTFE‐covered stent‐grafts (HR = 0.28, 95% confidence interval [CI] 0.20–0.35). Pooled encephalopathy data from three eligible studies suggested a significant reduction of risk in the PTFE‐covered group (HR = 0.65, 95%CI 0.45–0.86). Pooled survival data from four eligible studies also suggested a significant decrease of mortality in the PTFE‐covered group (HR = 0.76, 95%CI 0.58–0.94). No statistical heterogeneity was observed between studies for either outcome. Conclusions: This meta‐analysis shows that the use of PTFE‐covered stent‐grafts clearly improves shunt patency without increasing the risk of hepatic encephalopathy and with a trend towards better survival.     

超声造影在经颈静脉肝内门体支架分流术后支架管通畅性监测中的应用价值

目的评价超声造影(CEUS)在监测肝硬化患者经颈静脉肝内门体支架分流术(TIPS)后支架管通畅情况中的应用价值。方法回顾性分析2012年1—10月四川大学华西医院211例TIPS术后肝硬化患者的超声检查资料,其中40例行CEUS检查,14例行增强CT检查。以增强CT检查及临床随访结果作为金标准,分别计算彩色多普勒血流成像(CDFI)及CEUS诊断TIPS术后支架管闭塞的敏感度、特异度、阳性预测值及阴性预测值。结果二维超声显示所有支架管均位于门静脉与下腔静脉之间;CDFI显示171例患者支架管内血流充盈良好,38例支架管内未见血流信号,2例支架管血流充盈缺损。CEUS显示21例支架管通畅,17例支架管闭塞,2例支架管附壁血栓。17例CEUS诊断为支架管闭塞的患者中3例失访,14例行增强CT检查,均显示支架管闭塞。CDFI诊断TIPS术后支架管闭塞的敏感度、特异度、阳性预测者及阴性预测者分别为100%、89%、40%和100%;CEUS诊断TIPS术后支架管闭塞的敏感度、特异度、阳性预测者及阴性预测者均为100%。结论超声检查作为监测肝硬化患者TIPS术后支架管是否通畅的常规检查手段,CEUS能更加准确的显示支架管闭塞,尤其是CDFI显示支架管血流困难时采用CEUS可明确支架管的通畅情况。     

Combined TIPS with portal-azygous disconnection improved the long term clinical outcome in portal hypertension patients

Objective

The results of TIPS and the combined TIPS and portal-azygous disconnection for portal hypertension and variceal bleeding were evaluated.

Methods

358 patients with portal hypertension were admitted to our clinical ward because of variceal bleeding. 263 patients underwent TIPS and 95 patients with combined TIPS and portal-azygous disconnection. Portal hemodynamics was evaluated by pressure measurements, venography and Doppler ultrasound before and 2 weeks after the procedure. The rates of shunt patency, rebleeding, encephalopathy and survival were observed during the follow-up period from 1 to 10 years.

Results

The portal pressure and HVPG were decreased significantly after TIPS. TIPS procedure was successfully performed in 97.50% patients. During 1 month after treatment, acute shunt occlusion occurred in 3.42% patients with TIPS and there were no occluded shunts in patients with combined TIPS and portal-azygous disconnection. Encephalopathy was observed in 36.50% patients with TIPS and 18.95% with combined TIPS and portal-azygous disconnection. Recurrent variceal bleeding was documented in 6.46% patients with TIPS and none of patients with combined TIPS and azygous portal disconnection. Thirty-three patients with TIPS and two patients with combined TIPS and portal-azygous disconnection died. During follow-up periods, the patency of shunts in patients with TIPS and patients combined TIPS and azygous portal disconnection was 68.47, 43.84 and 87.06, 57.65% in 12 and 24 months after operation, respectively. The rates of rebleeding, and encephalopathy in patients with TIPS and patients with combined TIPS and azygous portal disconnection were 17.95, 31.79 and 7.04, 16.47%, respectively. The survival rate in 1, 5, 10 years in patients with TIPS and patients combined TIPS and azygous portal disconnection was 87.68, 51.23, 39.90 and 94.12, 81.18, 76.47%.

Conclusion

Combined TIPS and portal-azygous disconnection can improve the effect of TIPS for portal hypertension.     

Improved clinical outcome with transjugular intrahepatic portosystemic stent-shunt utilizing polytetrafluoroethylene-covered stents

BACKGROUND AND AIMS: Transjugular intrahepatic portosystemic stent-shunt (TIPSS) with standard uncovered stents has a 50% one-year primary patency rate, and is complicated by hepatic encephalopathy in 35% of patients. Newer covered stents appear to have improved patency. This large study aimed to assess the shunt function and clinical efficacy of polytetrafluoroethylene-covered stents in a single centre. METHODS: A total of 316 patients with uncovered stents before the introduction of covered stents (group 1) and 157 patients with the Viatorr Gore polytetrafluoroethylene-covered stents at the time of TIPSS creation (group 2) were studied. RESULTS: The mean follow-up was 22.8+/-25.4 and 13.1+/-12.5 months, respectively (P<0.01). Shunt insufficiency was greater in group 1 [54 versus 8% at 12 months; relative hazard (RH) 8.6; 95% confidence interval (CI) 4.8-15.5; P<0.001]. The incidence of variceal rebleeding was greater in group 1 (11 versus 6% at 12 months; RH 2.4; 95% CI 1.1-5.1; P<0.05). The incidence of hepatic encephalopathy was greater in group 1 (32 versus 22% at 12 months; RH 1.5; 95% CI 1.1-2.3; P<0.05). Mortality was similar in the two groups. CONCLUSION: The Viatorr type of polytetrafluoroethylene-covered stent results in vastly improved patency compared with uncovered stents, with reduced rates of variceal rebleeding and hepatic encephalopathy. This type of covered stent has the potential for superior clinical efficacy compared with uncovered stents.