Long-term follow-up of transjugular intrahepatic portosystemic shunt (TIPS) with stent-graft

Özet

PURPOSEWe aimed to retrospectively evaluate the long-term clinical and patency results after the placement of transjugular intrahepatic portosystemic shunts (TIPS) using stent-graft. Many studiesshow the clinical results and the patency follow-up of TIPS with stent-graft in the short and medium term. However, few studies show long-term results.METHODSBetween 2002 and 2016, TIPS with stent-grafts were placed in 132 patients. The median age was59.5 years. The median Model for End-stage Liver Disease (MELD) score was 13, and 71% wereChild-Pugh B. Indications for TIPS were bleeding (83%) and ascites or hydrothorax (17%). Thetechnical and clinical success rates were calculated, as were the rates of patency, survival andcomplications. The median follow-up period was 43 months.RESULTSThe technical success rate was 98%, and the clinical success rates were 85% in patients withindication for bleeding and 95% in patients with indication for ascites or hydrothorax. Primarypatency did not decrease from 66% after 6 years (95% confidence interval [CI], 56.2%–75.8%) primary assisted patency remained stable at 87% after 6 years (95% CI, 77.2%–96.8%) and secondary patency did not decrease from 98% after 4 years (95% CI, 95.1%–100%). The median overallsurvival was 42.8 months (95% CI, 33.8–51.8 months). A total of 54 patients suffered some type ofcomplication, minor (28 patients) or major (26 patients), during the follow-up.CONCLUSIONThe clinical success rate was high. The choice of the maximum initial limit of portosystemic gradient and the diameter of the post-TIPS shunt, together with the number of shunt reductions, areimportant to be able to compare results between publications. In our study, the patency rates didnot decrease after 6 years; hence, long-term follow-up of these patients may not be necessary