Hausegger Klaus A, Karnel Franz, Georgieva Buriana, Tauss Josef, Portugaller Horst, Deutschmann Hannes, Berghold Andrea
Department of Radiology, University Hospital Graz, Graz, Austria.
J Vasc Interv Radiol. 2004 Mar;15(3):239-48. doi: 10.1097/01.rvi.0000116194.44877.c1.
To evaluate the midterm clinical results and patency of transjugular portosystemic shunts (TIPS) created with a commercially available expanded polytetrafluoroethylene (ePTFE)-covered stent-graft based on angiographic and ultrasonographic (US) criteria in a series of 71 patients.
Seventy-one patients (61 men, 10 women; mean age, 58.6 years, range, 25-78 years) were included in this series, which was performed in two centers. Indications for TIPS creation were refractory ascites (n = 44) and recurrent esophageal bleeding (n = 27). Ten patients had Child-Pugh class A liver cirrhosis, 43 had class B disease, and 18 had class C disease. Underlying liver diseases were alcoholic cirrhosis (n = 58), cirrhosis resulting from hepatitis (n = 9), cryptogenic cirrhosis (n = 3), and Budd-Chiari syndrome (n = 1). TIPS were created with commercially available ePTFE-covered stent-grafts in all patients. The diameters of the stent-grafts were 10 mm in 58 patients and 8 mm in the remaining 13 patients. Follow-up included clinical examination and color-coded US after 5 days, 1, 3, and 6 months, and every 6 months thereafter. Shunt angiograms were obtained every 6 months. Median follow-up was 16.3 months (range, 3.8-26.6 months).
TIPS creation was successful in all patients without complications, and effective portal decompression was observed with a reduction of the mean portal gradient from 19 mm Hg to 6 mm Hg before and after TIPS creation. Four shunt occlusions were observed after 5 days, 2 months, 3 months, and 6 months. Shunt stenosis was observed in three patients at the hepatic vein, which was not fully covered by the stent-graft, after 6 months (n = 2) and 12 months, and at the portal side after 1 month in a patient who initially had portal vein thrombosis. The repeat intervention rate was 11.3%. The primary patency rates were 87.4% (95% CI, 77.7%-97.1%) after 6 months and 80.8% (95% CI, 68.2%-93.4%) after 12 months. The rate of de novo or deteriorated hepatic encephalopathy was 31%. The recurrent bleeding rate was 3.7% (one of 27), and ascites improved or resolved in 64% of patients after 1 month.
TIPS patency can be significantly increased if the ePTFE-covered stent-graft is used for shunt creation. The increased shunt patency contributes to low repeat intervention and recurrent bleeding rates. The rate of hepatic encephalopathy is within the range of previously reported rates.
基于血管造影和超声（US）标准，评估在71例患者中使用市售的膨体聚四氟乙烯（ePTFE）覆膜支架型人工血管创建的经颈静脉肝内门体分流术（TIPS）的中期临床结果和通畅性。
本研究纳入71例患者（61例男性，10例女性；平均年龄58.6岁，范围25 - 78岁），在两个中心进行。创建TIPS的指征为顽固性腹水（n = 44）和复发性食管出血（n = 27）。10例患者为Child-Pugh A级肝硬化，43例为B级疾病，18例为C级疾病。基础肝病包括酒精性肝硬化（n = 58）、肝炎后肝硬化（n = 9）、隐源性肝硬化（n = 3）和布加综合征（n = 1）。所有患者均使用市售的ePTFE覆膜支架型人工血管创建TIPS。58例患者的支架型人工血管直径为10 mm，其余13例患者为8 mm。随访包括术后5天、1、3和6个月以及此后每6个月进行的临床检查和彩色编码US。每6个月进行分流血管造影。中位随访时间为16.3个月（范围3.8 - 26.6个月）。
所有患者TIPS创建均成功且无并发症，观察到有效的门脉减压，TIPS创建前后平均门脉梯度从19 mmHg降至6 mmHg。术后5天、2个月、3个月和6个月观察到4例分流闭塞。6个月（n = 2）和12个月后，在3例肝静脉未被支架型人工血管完全覆盖的患者中观察到分流狭窄，1例最初有门静脉血栓形成的患者在术后1个月门静脉侧出现分流狭窄。再次干预率为11.3%。6个月时的主要通畅率为87.4%（95%CI，77.7% - 97.1%），12个月时为80.8%（95%CI，68.2% - 93.4%）。新发或恶化的肝性脑病发生率为31%。复发出血率为3.7%（27例中的1例），1个月后64%的患者腹水改善或消退。
如果使用ePTFE覆膜支架型人工血管创建分流，TIPS的通畅性可显著提高。分流通畅性的提高有助于降低再次干预和复发出血率。肝性脑病发生率在先前报道的范围内。
