Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2017; 23(26): 4779-4787
Published online Jul 14, 2017. doi: 10.3748/wjg.v23.i26.4779
Effect of initial stent position on patency of transjugular intrahepatic portosystemic shunt
Shi-Hua Luo, Jian-Guo Chu, He Huang, Ke-Chun Yao
Shi-Hua Luo, Jian-Guo Chu, He Huang, Department of Radiology, Air Force General Hospital of PLA, Beijing 100142, China
Ke-Chun Yao, Department of Ultrasound, Air Force General Hospital of PLA, Beijing 100142, China
Author contributions: Luo SH and Chu JG designed the research; Luo SH and Huang H performed the research; Luo SH analyzed the data; Luo SH and Huang H wrote the paper; Yao KC revised the paper.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Air Force General Hospital of PLA, Beijing, China.
Informed consent statement: Patients were not required to give informed consent because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors declare that there is no conflict of interest related to this study.
Data sharing statement: No additional data are available.
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: Jian-Guo Chu, Professor, Department of Radiology, Air Force General Hospital of PLA, 30 Fucheng Road, Haidian District, Beijing 100142, China. cjgchina@126.com
Telephone: +86-10-66928523 Fax: +86-10-66928523
Received: March 9, 2017
Peer-review started: March 10, 2017
First decision: March 30, 2017
Revised: April 20, 2017
Accepted: May 19, 2017
Article in press: May 19, 2017
Published online: July 14, 2017
Abstract
AIM

To evaluate the effect of initial stent position on transjugular intrahepatic portosystemic shunt (TIPS).

METHODS

We studied 425 patients from January 2004 to January 2015 with refractory ascites or variceal bleeding who required TIPS placement. Patients were randomly divided into group A (stent in hepatic vein, n = 57), group B (stent extended to junction of hepatic vein and inferior vena cava, n = 136), group C (stent in left branch of portal vein, n = 83) and group D (stent in main portal vein, n = 149). Primary unassisted patency was compared using Kaplan-Meier analysis, and incidence of recurrence of bleeding, ascites and hepatic encephalopathy (HE) were analyzed.

RESULTS

The mean primary unassisted patency rate in group B tended to be higher than in group A at 3, 6 and 12 mo (P = 0.001, 0.000 and 0.005), and in group D it tended to be lower than in group C at 3, 6 and 12 mo (P = 0.012, 0.000 and 0.028). The median shunt primary patency time for group A was shorter than for group B (5.2 mo vs 9.1 mo, 95%CI: 4.3-5.6, P = 0.013, log-rank test), while for group C it was longer than for group D (8.3 mo vs 6.9 mo, 95%CI: 6.3-7.6, P = 0.025, log-rank test). Recurrence of bleeding and ascites in group A was higher than in group B at 3 mo (P = 0.014 and 0.020), 6 mo (P = 0.014 and 0.019) and 12 mo (P = 0.024 and 0.034. Recurrence in group D was higher than in group C at 3 mo (P = 0.035 and 0.035), 6 mo (P = 0.038 and 0.022) and 12 mo (P = 0.017 and 0.009). The incidence of HE was not significantly different among any of the groups (P = 0.965).

CONCLUSION

The initial stent position can markedly affect stent patency, which potentially influences the risk of recurrent symptoms associated with shunt stenosis or occlusion.

Keywords: Transjugular intrahepatic portosystemic shunt, Liver cirrhosis, Stent position, Portal hypertension

Core tip: We studied a large cohort of patients with cirrhosis who underwent transjugular intrahepatic portosystemic shunt for recurrent variceal bleeding and ascites. Initial stent position at both the distal and proximal endpoints can markedly affect stent patency, which potentially influences the risk of recurrent symptoms associated with shunt stenosis or occlusion.