TIPS for Refractory Ascites: A 6-Year Single-Center Experience With Expanded Polytetrafluoroethylene-Covered Stent-Grafts

被引:31
作者
Bercu, Zachary L. [1 ]
Fischman, Aaron M. [1 ]
Kim, Edward [1 ]
Nowakowski, F. Scott [1 ]
Patel, Rahul S. [1 ]
Schiano, Thomas D. [2 ]
Chang, Charissa Y. [2 ]
Lookstein, Robert A. [1 ]
机构
[1] Icahn Sch Med Mt Sinai, Div Intervent Radiol, Dept Radiol, New York, NY 10029 USA
[2] Icahn Sch Med Mt Sinai, Recanati Miller Transplantat Inst, Div Liver Dis, New York, NY 10029 USA
关键词
cirrhosis; expanded polytetrafluoroethylene (ePTFE)-covered stent; portal hypertension; refractory ascites; transjugular intrahepatic portosystemic shunt (TIPS); INTRAHEPATIC PORTOSYSTEMIC SHUNT; PARACENTESIS PLUS ALBUMIN; PORTAL-HYPERTENSION; CONSENSUS WORKSHOP; CURRENT MANAGEMENT; COMPLICATIONS; CIRRHOSIS; METAANALYSIS; METHODOLOGY; DIAGNOSIS;
D O I
10.2214/AJR.14.12885
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
OBJECTIVE. This single-center study evaluated the use of expanded polytetrafluoroethylene (ePTFE)-covered stent-grafts for transjugular intrahepatic portosystemic shunt (TIPS) placement to manage portal hypertension-related refractory ascites. MATERIALS AND METHODS. One hundred patients at a single tertiary care center in a major metropolitan hospital underwent TIPS placement with an ePTFE-covered stent-graft (Viatorr TIPS Endoprosthesis). Patients with portal hypertension-related ascites and preexisting hepatocellular carcinoma or liver transplant were excluded from the analysis. Records were reviewed for demographic characteristics, technical success of the TIPS procedures, and stent follow-up findings. Clinical results were assessed at 90- and 180-day intervals. RESULTS. Immediate technical success of the TIPS procedure was 100%. Of the 61 patients with documented follow-up, 55 (90.2%) had a partial or complete ascites response to TIPS creation. Of these 55 patients, nine experienced severe encephalopathy. Six of 61 patients (9.8%) did not experience a significant ascites response. Overall survival was 78.7% at 365-day follow-up. The 365-day survival was 84.2% for patients with a model for end-stage liver disease (MELD) score of less than 15, 67.0% for those with a score of 15-18, and 53.8% for those with a score of greater than 18 (p = 0.01). For patients with a MELD score of less than 18, the 365-day survival was 88.0% for those with an albumin value of 3 mg/dL or greater and 72.8% for those with an albumin value of less than 3 mg/dL (p = 0.04). CONCLUSION. TIPS placement using an ePTFE-covered stent-graft is an efficacious therapy for refractory ascites. Patients with preserved liver function-characterized by a MELD score of less than 15 or a MELD score of less than 18 and an albumin value of 3 mg/dL or greater-experience the greatest survival benefit.
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收藏
页码:654 / 661
页数:8
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