Liu Jiacheng, Meng Jie, Zhou Chen, Shi Qin, Yang Chongtu, Ma Jinqiang, Chen Manman, Xiong Bin
Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
J Interv Med. 2020 Oct 13;4(1):32-38. doi: 10.1016/j.jimed.2020.10.003. eCollection 2021 Feb.
To compare the clinical outcomes in terms of structure and function between the insertion of a transjugular intrahepatic portosystemic shunt (TIPS) created with the Viabahn ePTFE covered stent/bare metal stent (BMS) combination and the Fluency ePTFE covered stent/BMS combination.
A total of 101 consecutive patients who received a TIPS from February 2016 to August 2018 in our center were retrospectively analyzed. Sixty-four subjects were enrolled in the Viabahn group and 37 were enrolled in the Fluency group. The geometry characteristics of the TIPS were calculated, and the associated occurrence of shunt dysfunction, survival, overt hepatic encephalopathy, and variceal rebleeding were evaluated.
The technical success rate was 100%. After the insertion of the TIPS, the rate of shunt dysfunction during the first 3 months was significantly different between the Viabahn and Fluency groups (1.6% and 13.5%, respectively; p = 0.024). Multivariate analysis indicated that the angle of portal venous inflow (α) was the only independent risk factor for shunt dysfunction (hazard ratio = 1.060, 95% confidence interval = 1.009-1.112, p = 0.020). In addition, 3 months after the TIPS insertion, the α angle distinctly increased from 20.9° ± 14.3°-26.9° ± 20.1° (p = 0.005) in the Fluency group but did not change significantly in the Viabahn group (from 21.9° ± 15.1°-22.9° ± 17.6°, p = 0.798).
Shunt dysfunction was related to the α angle owing to the slight effect on the α angle after the implantation of the TIPS. The Viabahn ePTFE covered stent/BMS combination was more stable in structure and promised higher short-term stent patency compared with the Fluency ePTFE covered stent/BMS combination.
比较使用Viabahn ePTFE覆膜支架/裸金属支架（BMS）组合与Fluency ePTFE覆膜支架/BMS组合创建经颈静脉肝内门体分流术（TIPS）在结构和功能方面的临床结果。
回顾性分析2016年2月至2018年8月在本中心接受TIPS的101例连续患者。64例受试者纳入Viabahn组，37例纳入Fluency组。计算TIPS的几何特征，并评估分流功能障碍、生存率、显性肝性脑病和静脉曲张再出血的相关发生率。
技术成功率为100%。TIPS植入后，Viabahn组和Fluency组前3个月内的分流功能障碍发生率有显著差异（分别为1.6%和13.5%；p = 0.024）。多因素分析表明，门静脉流入角度（α）是分流功能障碍的唯一独立危险因素（风险比 = 1.060，95%置信区间 = 1.009 - 1.112，p = 0.020）。此外，TIPS植入3个月后，Fluency组的α角从20.9°±14.3°明显增加至26.9°±20.1°（p = 0.005），而Viabahn组无显著变化（从21.9°±15.1°至22.9°±17.6°，p = 0.798）。
由于TIPS植入后对α角影响较小，分流功能障碍与α角有关。与Fluency ePTFE覆膜支架/BMS组合相比，Viabahn ePTFE覆膜支架/BMS组合结构更稳定，短期支架通畅率更高。
