Premium
Survival in patients undergoing transjugular intrahepatic portosystemic shunt: ePTFE‐covered stentgrafts versus bare stents
Author(s) -
Angermayr Bernhard,
Cejna Manfred,
Koenig Franz,
Karnel Franz,
Hackl Franz,
Gangl Alfred,
PeckRadosavljevic Markus
Publication year - 2003
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.1840380431
Subject(s) - medicine , transjugular intrahepatic portosystemic shunt , surgery , cirrhosis , proportional hazards model , portal hypertension , hepatology , stent , survival rate , survival analysis , retrospective cohort study
In patients with liver cirrhosis, implantation of a transjugular intrahepatic shunt (TIPS) leads to reduction of portal pressure, but not of mortality compared with other therapies. The high stenosis rates of conventional bare stents causes high reintervention rates and costs and may be correlated with poor survival. ePTFE‐covered stentgrafts provide much improved patency rates, but their impact on survival is unclear. All suitable patients receiving either bare TIPS (419/466) or undergoing implantation of ePTFE endoprostheses (89/100) in several centers in Austria up to 2002 were included in this retrospective analysis. Both patient groups were compared regarding survival with Kaplan‐Meier and Cox regression analysis. Unmatched and 1:1‐matched survival analyses were performed. Patients undergoing ePTFE stentgraft implantation had significantly higher survival rates in all analyses. The 3‐month, 1‐year, and 2‐year survival rates were 93%, 88%, and 76% for the ePTFE‐group and 83%, 73%, and 62% for conventional TIPS patients, respectively. The matched survival analyses validated these findings. The model of the stent, patient age, and Child‐Pugh Class (CPC) were independent predictors of survival. In conclusion, patients undergoing ePTFE‐endoprosthesis implantation had higher survival rates within 2 years after TIPS‐implantation. This may be the result of improved patency rates after correct placement (up to the inferior caval vein [ICV]) of the ePTFE stentgraft. These data should be validated in a prospective series. (Hepatology 2003;38:1043–1050).