From the Departments of Radiology (G.H., M.R., A.S., M.A.R., M.Z., V.V.) and Hepatology (A.P., P.E.R., D.V.), APHP, University Hospitals Paris Nord Val de Seine, Beaujon Hospital, 100 Boulevard du Général Leclerc, 92118 Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France (M.R., P.E.R., D.V., V.V.); and INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France (M.R., V.V.).
Radiology. 2017 Apr;283(1):280-292. doi: 10.1148/radiol.2016152641. Epub 2016 Oct 31.
Purpose To evaluate the long-term safety, technical success, and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in a series of patients with Budd-Chiari syndrome (BCS), and to determine the predictors of shunt dysfunction. Materials and Methods From 2004 to 2013, all patients with primary BCS referred for TIPS placement were included in the study. The primary and secondary technical success rates and the number and types of early (ie, before day 7) complications were noted. Factors associated with dysfunction were analyzed with uni- and multivariate analyses. Survival was analyzed with Kaplan-Meier curves. Results Fifty-four patients (34 women [63%]; mean age, 36 years ± 12 [standard deviation]) were included. Twenty-eight patients (52%) had myeloproliferative neoplasms. The mean Model for End-Stage Liver Disease score was 14.5 ± 4. The most frequent indication for TIPS was refractory ascites (50 of 54; 93%). Primary and secondary technical success rates were 93% and 98%, respectively. Early complications occurred in 17 patients (32%). After a mean follow-up of 56 months ± 41 (interquartile range, 22-92), 22 patients (42%) experienced at least one episode of TIPS dysfunction (median delay between administration of TIPS and first episode of dysfunction, 10.8 months). Cumulative 1-, 2-, 3-, 5-, and 10-year primary patency rates were 64%, 59%, 54%, 45%, and 45%, respectively. Dysfunction was associated with a myeloproliferative neoplasm (hazard ratio, 8.18; 95% confidence interval: 1.45, 46.18; P = .017), more than two initial stents (hazard ratio, 3.90; 95% confidence interval:1.16, 13.10; P = .027), and the occurrence of early complications (hazard ratio, 11.34; 95% confidence interval: 1.82, 70.69; P = .009). The 10-year survival rate was 76%. Conclusion TIPS placement in patients with chronic primary BCS was associated with a nonnegligible rate of early complications and required endovascular revision or revisions in 42% of patients. Nevertheless, secondary patency was close to 100%, and long-term survival was good. RSNA, 2016 Online supplemental material is available for this article.
评估经颈静脉肝内门体分流术（TIPS）在一系列布加氏综合征（BCS）患者中的长期安全性、技术成功率和疗效，并确定分流功能障碍的预测因素。
2004 年至 2013 年，所有因 TIPS 放置而转介的原发性 BCS 患者均纳入本研究。记录主要和次要技术成功率以及早期（即，<7 天）并发症的数量和类型。采用单变量和多变量分析来分析与功能障碍相关的因素。采用 Kaplan-Meier 曲线分析生存情况。
54 例患者（34 例女性[63%]；平均年龄 36 岁±12[标准差]）纳入研究。28 例（52%）患者患有骨髓增生性肿瘤。终末期肝病模型评分的平均值为 14.5±4。TIPS 最常见的适应证是难治性腹水（50/54；93%）。主要和次要技术成功率分别为 93%和 98%。17 例（32%）患者发生早期并发症。在平均 56 个月±41（中位数 22-92）的随访后，22 例（42%）患者至少发生了 1 次 TIPS 功能障碍（TIPS 治疗后至首次功能障碍的中位延迟时间为 10.8 个月）。累积 1、2、3、5 和 10 年的主通畅率分别为 64%、59%、54%、45%和 45%。功能障碍与骨髓增生性肿瘤相关（风险比，8.18；95%置信区间：1.45，46.18；P=.017），初始支架多于 2 个（风险比，3.90；95%置信区间：1.16，13.10；P=.027），以及早期并发症的发生（风险比，11.34；95%置信区间：1.82，70.69；P=.009）。10 年生存率为 76%。
在慢性原发性 BCS 患者中，TIPS 放置与较高的早期并发症发生率相关，42%的患者需要血管内修复或多次修复。然而，二级通畅率接近 100%，长期生存率较好。
RSNA，2016 年
在线补充材料可在本文中获取。
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