Weber Charles N, Nadolski Gregory J, White Sarah B, Clark Timothy W I, Mondschein Jeffrey I, Stavropoulos S William, Shlansky-Goldberg Richard D, Trerotola Scott O, Soulen Michael C
Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania..
Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
J Vasc Interv Radiol. 2015 Sep;26(9):1257-65; quiz 1265. doi: 10.1016/j.jvir.2015.04.005. Epub 2015 May 16.
To evaluate long-term patency and symptomatic recurrence rates following transjugular intrahepatic portosystemic shunt (TIPS) creation with expanded polytetrafluoroethylene (ePTFE)-covered stent grafts and to determine the necessity of extended clinical follow-up beyond 2 years after TIPS creation.
A retrospective review including 262 TIPSs created with ePTFE-covered stent grafts between July 2002 and October 2012 was performed. Primary, primary assisted, and secondary patency rates were calculated. Assessment of clinical data included technical, hemodynamic, and clinical success rates, as well as mortality after TIPS creation.
Primary patency rates at 2, 4, and 6 years were 74%, 62%, and 50%, respectively. Primary assisted patency rates at 2, 4, and 6 years were 93%, 85%, and 78%, respectively. Secondary patency rates at 2, 4, and 6 years were 99%, 91%, and 84%, respectively. Technical and hemodynamic success rates were 99% and 93%, respectively. Clinical success rates for refractory ascites were 66% (complete response) and 90% (partial response); clinical success rate for bleeding/varices was 90%. Mortality rates at 2, 4, and 6 years after TIPS creation were 27%, 38%, and 46%, respectively. At the median wait time until transplantation, patients had an 84% chance of being alive. TIPS dysfunction developed in 21% of patients; 30% of revisions occurred later than 2 years during follow-up.
Beyond 2 years after TIPS creation, patency rates gradually decrease, mortality rates continue to increase, and the chance of recurrent ascites or bleeding remains present. Together, these findings suggest that continued clinical follow-up beyond 2 years is necessary in patients with a TIPS created with an ePTFE-covered stent graft.
评估使用膨体聚四氟乙烯（ePTFE）覆膜支架型人工血管建立经颈静脉肝内门体分流术（TIPS）后的长期通畅率和症状复发率，并确定TIPS建立后2年以上进行长期临床随访的必要性。
对2002年7月至2012年10月期间使用ePTFE覆膜支架型人工血管建立的262例TIPS进行回顾性分析。计算了初次通畅率、初次辅助通畅率和二次通畅率。临床数据评估包括技术成功率、血流动力学成功率、临床成功率以及TIPS建立后的死亡率。
2年、4年和6年的初次通畅率分别为74%、62%和50%。2年、4年和6年的初次辅助通畅率分别为93%、85%和78%。2年、4年和6年的二次通畅率分别为99%、91%和84%。技术成功率和血流动力学成功率分别为99%和93%。难治性腹水的临床成功率为66%（完全缓解）和90%（部分缓解）；出血/静脉曲张的临床成功率为90%。TIPS建立后2年、4年和6年的死亡率分别为27%、38%和46%。在等待移植的中位时间，患者存活的几率为84%。21%的患者出现TIPS功能障碍；30%的翻修发生在随访2年之后。
TIPS建立后2年以上，通畅率逐渐下降，死亡率持续上升，腹水或出血复发的可能性仍然存在。综合这些发现表明，对于使用ePTFE覆膜支架型人工血管建立TIPS的患者，2年以上持续的临床随访是必要的。
