Effect of technical parameters on transjugular intrahepatic portosystemic shunts utilizing stent grafts

摘要

AIM: To assess the effect of technical parameters on outcomes of transjugular intrahepatic portosystemic shunt(TIPS) created using a stent graft.METHODS: The medical records of 68 patients who underwent TIPS placement with a stent graft from 2008 to 2014 were reviewed by two radiologists blinded to the patient outcomes.Digital Subtraction Angiographic images with a measuring catheter in two orthogonal planes was used to determine the TIPS stent-to-inferior vena cava distance(SIVCD),hepatic vein to parenchymal tract angle(HVTA),portal vein to parenchymal tract angle(PVTA),and the accessed portal vein.The length and diameter of the TIPS stent and the use of concurrent variceal embolization were recorded by review of the patient's procedure note.Data on re-intervention within 30 d of TIPS placement,recurrence of symptoms,and survival were collected through the patient's chart.Cox proportional regression analysis was performed to assess the effect of these technical parameters on primary patency of TIPS,time to recurrence of symptoms,and all-cause mortality.RESULTS: There was no significant associationbetween the SIVCD and primary patency(P = 0.23),time to recurrence of symptoms(P = 0.83),or allcause mortality(P = 0.18).The 3,6,and 12-mo primary patency rates for a SIVCD ≥ 1.5 cm were 82.4%,64.7%,and 50.3% compared to 89.3%,83.8%,and 60.6% for a SIVCD of < 1.5 cm(P = 0.29).The median time to stenosis for a SIVCD of ≥ 1.5 cm was 19.1 mo vs 15.1 mo for a SIVCD of < 1.5 cm(P = 0.48).There was no significant association between the following factors and primary patency: HVTA(P = 0.99),PVTA(P = 0.65),accessed portal vein(P = 0.35),TIPS stent diameter(P = 0.93),TIPS stent length(P = 0.48),concurrent variceal embolization(P = 0.13) and reinterventions within 30 d(P = 0.24).Furthermore,there was no correlation between these technical parameters and time to recurrence of symptoms or all-cause mortality.Recurrence of symptoms was associated with stent graft stenosis(P = 0.03).CONCLUSION: TIPS stent-to-caval distance and other parameters have no significant effect on primary patency,time to recurrence of symptoms,or all-cause mortality following TIPS with a stent-graft.