Transjugular intrahepatic
portosystemic shunt (
TIPS) have been shown to be an efficient portal-systemic derivative treatment for
Budd-Chiari syndrome (BCS) patients uncontrolled by medical
therapy. However, the main drawback of
TIPS for this condition is a very high rate of shunt dysfunction. Recently,
polytetrafluoroethylene (
PTFE)-covered
stents have been shown to reduce the incidence of
TIPS dysfunction in patients with
cirrhosis. The aim of the study was to assess the incidence of
TIPS dysfunction in 2 cohorts of BCS patients treated with bare or
PTFE-covered
stents. The study included 25
TIPS procedures (16 bare
stents and 9 covered
stents) with a median follow-up period of 20.4 months (range, 3.9-124.8). Fourteen of 16 patients (87%) receiving bare
stents had
TIPS dysfunction compared to 3 of the 9 patients (33%) receiving
PTFE-covered
stents (P = .005). The actuarial rates of primary patency in the bare-
stent group were 19% at 1 year compared with 67% in the
PTFE-covered
stent group (P = .02; log-rank test). The number of additional interventional procedures to maintain
TIPS patency was significantly greater in the bare-
stent than in the
PTFE-covered
stent group (1.9 +/- 1.2 vs. 0.6 +/- 0.9; P = .007). The number of patients with clinical relapses was greater in the bare-
stent group compared to the
PTFE-covered
stent group (13 vs. 5 episodes in 9 and 3 patients, respectively). In conclusion,
PTFE-covered
stents have a considerable advantage over bare
stents for the
TIPS treatment of BCS patients, with a lower dysfunction rate, a lower number of reinterventions, and fewer
prosthesis requirements.
PTFE-covered
stents are preferable in patients with
Budd-Chiari Syndrome.