Construction of Transjugular Intrahepatic Portosystemic Shunt: Bare Metal Stent/Stent-graft Combination versus Single Stent-graft, a Prospective Randomized Controlled Study with Long-term Patency and Clinical Analysis

Autor: Jun Zhao, Jun Fu, Xuan Li, Jing-yuan Luan, Chang-ming Wang, Guo-xiang Dong, Tian-run Li
Jazyk: angličtina
Rok vydání: 2016
Předmět:
Male
Bare-metal stent
medicine.medical_specialty
medicine.medical_treatment
lcsh:Medicine
Esophageal and Gastric Varices
030218 nuclear medicine & medical imaging
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Hypertension
Portal
Stent
medicine
Humans
Prospective Studies
Prospective cohort study
Polytetrafluoroethylene
Survival rate
Hepatic encephalopathy
Aged
Interventional
Hypertension
Portal Vein
business.industry
lcsh:R
General Medicine
Middle Aged
medicine.disease
equipment and supplies
Portal
Radiology
Surgery
Treatment Outcome
surgical procedures
operative
Hepatic Encephalopathy
Portal hypertension
Original Article
Female
Stents
030211 gastroenterology & hepatology
Liver function
Portasystemic Shunt
Transjugular Intrahepatic
business
Transjugular intrahepatic portosystemic shunt
Zdroj: Chinese Medical Journal, Vol 129, Iss 11, Pp 1261-1267 (2016)
Chinese Medical Journal
ISSN: 0366-6999
Popis: Background: Balanced adjustment of the portal vein shunt volume during a transjugular intrahepatic portosystemic shunt (TIPS) is critical for maintaining liver perfusion and decreasing the incidence of liver insufficiency. A stent-graft is proved to be superior to a bare metal stent (BMS) for the construction of a TIPS. However, the clinical results of the combination application of stents and stent-grafts have not been determined. This study aimed to compare the technique of using a combination of stents and stent-grafts with using a single stent-graft to construct a TIPS. Methods: From April 2011 to November 2014, a total of fifty patients were randomly assigned to a stents-combination group (Group I, n = 28) or a stent-graft group (Group II, n = 22). Primary patency rates were calculated. Clinical data, including the technical success rate, bleeding control results, incidence of encephalopathy, liver function preservation, and survival rate, were assessed. Results: Technically, the success rate was 100% for both groups. The primary patency rates at 1, 2, and 3 years for Group I were 96%, 84%, and 77%, respectively; for Group II, they were 90%, 90%, and 78%, respectively. The survival rates at 1, 2, and 3 years for Group I were 79%, 74%, and 68%, respectively; for Group II, they were 82%, 82%, and 74%, respectively. The incidence of hepatic encephalopathy was 14.3% for Group I and 13.6% for Group II. The Child-Pugh score in Group I was stable at the end of the follow-up but had significantly increased in Group II ( t = −2.474, P = 0.022). Conclusions: The construction of a TIPS with either the single stent-graft or BMS/stent-graft combination is effective for controlling variceal bleeding. The BMS/stent-graft combination technique is superior to the stent-graft technique in terms of hepatic function preservation indicated by the Child-Pugh score. However, considering the clinical results of the TIPS, the two techniques are comparable in their primary shunt patency, incidence of encephalopathy and patient survival during the long-term follow-up.
Databáze: OpenAIRE
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