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PURPOSE: To evaluate the safety and efficacy of 12mm diameter PTFE-covered stents for the creation of TIPS in cirrhotic patients with portal hypertension complicated by variceal bleeding and volume-overload.
METHODS: This retrospective study included 360 patients who had TIPS created between January 2004 and December 2017 using 12mm diameter PTFE-covered stents. Demographic data, model for end-stage liver disease (MELD) score, etiology of cirrhosis, and Charlson co-morbidity index were recorded. Symptoms of hepatic encephalopathy (HE), variceal re-bleeding, improvement in volume-overload, TIPS revisions and the need for intervention, and overall survival were assessed.
RESULTS: The mean age of the patients was 56.8 years (SD=9.9), and the technical success was 99.4%. The rates of improvement of volume-overload post-TIPS were 59.5%, 69.8% and 81.7% at three, six and 12 months, respectively. 93.3% of patients were free from paracentesis or thoracentesis at 12 months. The rates of re-bleeding post-TIPS were 4%, 12% and 12.9% at three, six, and 12 months, respectively. The rate of TIPS revision at 12 months was 6.5%. Percentage of patients with any symptoms of HE were 34.4%, 42.9% and 49.5% at three, six, and 12 months, respectively. All HE was appropriately medically managed and no patients required a TIPS reduction.
CONCLUSION: TIPS placement using 12mm PTFE-covered stents is efficacious in cirrhotic patients with portal hypertension complicated by variceal bleeding or refractory volume-overload, with an acceptable safety profile.