The purpose of this study was to assess the therapeutic efficacy and immediate and long-term safety of expanded-
tetrafluoroethylene covered
stent-grafts for transjugular intrahepatic
portosystemic shunts in patients with
portal hypertension-related complications. A cohort of 56 patients suffering from severe
portal hypertension-related complications underwent implantation of an expanded-
polytetrafluoroethylene-covered
stent-graft. All patients suffered from severe
liver cirrhosis graded Child-Pugh A (n=8; 16%), B (n=13; 21%) or C (n=35; 63%). In 44 patients, the
stent-graft was placed during the initial
TIPS procedure (de novo
TIPS); in the other 12 patients, the
stent-graft was placed to repermeabilize the previously placed bare
stent (
TIPS revision). Follow-up was performed with clinical assessment, duplex ultrasound and, if abnormal or inconclusive, with invasive venography and pressure measurements. Per- en immediate post-procedural complications occurred in four patients (4/56, 7%). None of them was lethal. During follow-up,
stent occlusion appeared in one patient and
stenosis in two; no recurrence of
bleeding was noted in all patients treated for variceal
bleeding (n=28), and 24 of the 28 patients (86%) suffering from refractory
ascites and/or hepatic
hydrothorax were free of regular paracenteses and/or drainage of
pleural effusion after shunt creation. The 30-day and global mortality for the total study population (n=56) was, respectively, 7% (n=4) and 28.5% (n=16). In the patient subgroup with variceal
bleeding (n=28), 30-day mortality was 3.5% (n=1) and global mortality 14.2% (n=4). In the
ascites and/or
hydrothorax subgroup (n=28), 8.1% (n=3) mortality at 30 days was found and global mortality was 32.4% (n=12). In 10 patients of the 56 studied patients (18%), isolated
hepatic encephalopathy occurred, which was lethal in 4 (Child C) patients (7%). Three of these four patients died within the 1st month after
TIPS placement. A very high primary patency rate of
TIPS can be obtained long-term after implantation of an e-
PTFE-covered
stent-graft, leading to a definitive resolution of
portal hypertension-related complications. The incidence of
TIPS-induced
hepatic encephalopathy is acceptable.