Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2015; 21(26): 8110-8117
Published online Jul 14, 2015. doi: 10.3748/wjg.v21.i26.8110
Effect of technical parameters on transjugular intrahepatic portosystemic shunts utilizing stent grafts
Brice Andring, Sanjeeva P Kalva, Patrick Sutphin, Rajiv Srinivasa, Alvin Anene, Marc Burrell, Yin Xi, Anil K Pillai
Brice Andring, Sanjeeva P Kalva, Patrick Sutphin, Rajiv Srinivasa, Alvin Anene, Marc Burrell, Yin Xi, Anil K Pillai, Department of Radiology, University of Texas-Southwestern, Dallas, TX 75219, United States
Author contributions: Andring B collected the data, analyzed the data, and drafted the manuscript; Pillai AK and Kalva SP provided analytical oversight, supervised the study, and made revisions to the manuscript; Burrell M helped with the study design and data collection tools; Xi Y provided statistically analysis; Pillai AK, Sutphin P, Anene A and Srinivasa R helped with data collection; all authors have read and approved the final version to be published.
Institutional review board statement: The UT Southwestern Institutional Review Board (IRB) reviewed the above-referenced research study via an expedited review procedure on November 27, 2013 in accordance with 45 CFR 46.110(a)-(b)(1). Having met all applicable requirements, the research study is approved. The approval period for this research study begins on November 27, 2013 and lasts until November 26, 2014.
Informed consent statement: Need for informed consent was waived by University of Texas-Southwestern/Parkland hospitals.
Conflict-of-interest statement: The authors have no conflicts of interest to report.
Data sharing statement: The signed statement has been uploaded to the site.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Brice Andring, MD, Department of Radiology, University of Texas-Southwestern, Radiology 5323 Harry Hines Blvd. Dallas, TX 75219, United States. brice.andring@phhs.org
Telephone: +1-214-6458990 Fax: +1-214-6458998
Received: January 27, 2015
Peer-review started: February 10, 2015
First decision: March 10, 2015
Revised: March 25, 2015
Accepted: May 2, 2015
Article in press: May 4, 2015
Published online: July 14, 2015
Processing time: 168 Days and 4 Hours
Abstract

AIM: To assess the effect of technical parameters on outcomes of transjugular intrahepatic portosystemic shunt (TIPS) created using a stent graft.

METHODS: The medical records of 68 patients who underwent TIPS placement with a stent graft from 2008 to 2014 were reviewed by two radiologists blinded to the patient outcomes. Digital Subtraction Angiographic images with a measuring catheter in two orthogonal planes was used to determine the TIPS stent-to-inferior vena cava distance (SIVCD), hepatic vein to parenchymal tract angle (HVTA), portal vein to parenchymal tract angle (PVTA), and the accessed portal vein. The length and diameter of the TIPS stent and the use of concurrent variceal embolization were recorded by review of the patient’s procedure note. Data on re-intervention within 30 d of TIPS placement, recurrence of symptoms, and survival were collected through the patient’s chart. Cox proportional regression analysis was performed to assess the effect of these technical parameters on primary patency of TIPS, time to recurrence of symptoms, and all-cause mortality.

RESULTS: There was no significant association between the SIVCD and primary patency (P = 0.23), time to recurrence of symptoms (P = 0.83), or all-cause mortality (P = 0.18). The 3, 6, and 12-mo primary patency rates for a SIVCD ≥ 1.5 cm were 82.4%, 64.7%, and 50.3% compared to 89.3%, 83.8%, and 60.6% for a SIVCD of < 1.5 cm (P = 0.29). The median time to stenosis for a SIVCD of ≥ 1.5 cm was 19.1 mo vs 15.1 mo for a SIVCD of < 1.5 cm (P = 0.48). There was no significant association between the following factors and primary patency: HVTA (P = 0.99), PVTA (P = 0.65), accessed portal vein (P = 0.35), TIPS stent diameter (P = 0.93), TIPS stent length (P = 0.48), concurrent variceal embolization (P = 0.13) and reinterventions within 30 d (P = 0.24). Furthermore, there was no correlation between these technical parameters and time to recurrence of symptoms or all-cause mortality. Recurrence of symptoms was associated with stent graft stenosis (P = 0.03).

CONCLUSION: TIPS stent-to-caval distance and other parameters have no significant effect on primary patency, time to recurrence of symptoms, or all-cause mortality following TIPS with a stent-graft.

Keywords: Transjugular intrahepatic portosystemic shunt; Stents; Mortality; Portal Hypertension; Technique; Outcomes

Core tip: Current knowledge on the technical factors influencing the patency of transjugular intrahepatic portosystemic shunts (TIPS) is limited to the published data on TIPS created using bare-metal stents. However, stent grafts have replaced bare metal stents in TIPS creation. In this paper, we rigorously analyzed the effects of various technical factors on patency of TIPS created with stent grafts and also demonstrated how these factors influenced time to recurrence of symptoms and all-cause mortality. Our results challenge the accepted assumption that placement of the hepatic venous end of the stent beyond 1.5 cm of the hepatocaval confluence decreases primary shunt patency rates.