Ulrike Koch, Presenter: Nothing to Disclose

Roman Kloeckner MED, Abstract Co-Author: Nothing to Disclose

Jens Schneider, Abstract Co-Author: Nothing to Disclose

Christoph Düber MD, Abstract Co-Author: Nothing to Disclose

Michael Bernhard Pitton MD, Abstract Co-Author: Nothing to Disclose

To evaluate the technical results and mid-term clinical outcomes after TIPS with e-PTFE-covered stentgrafts in refractory ascites or acute variceal bleeding.

From July 2002 to July 2009, 127 patients (74 male, 53 female, age 56.6±13.3 years, range 24-85 years) were treated with TIPS using e-PTFE covered stentgrafts for refractory ascites (n=100) or recurrent variceal bleeding (n=27). Underlying disease included alcoholism (n=72), Hepatitis C (n=17), Budd-Chiari-Syndrome (n=11), Hepatitis B (n=9), others (n=9), and cryptogenic cirrhosis(n=9). 18/127 (14.2%) were treated on an emergency basis. Patients were categorized as Child-Pugh A (n=5), B (n=85), and C (n=37). Portosytemic pressure gradient (PSG) was obtained immediately before stentgrafting and after TIPS completion. Follow-up included clinical visits, laboratory findings, Duplex sonography, and MDCT or MRI.

TIPS procedures were technically successful in all cases. PSG was significantly reduced from 23.1±5.7mmHg to 6,9±3,7mmHg, mean PSG-reduction was 13.9±5,1mmHg. There was one peri-procedural death due to post-interventional abdominal bleeding (0.8%). 30-day mortality was 3/100 (3%) for refractory ascites compared to 6/27 (22.2%) for variceal bleeding. Follow up is 23.1±15.7 months (range 0-69). TIPS revisions occurred in 36/127 patients (28.3%), including restoration of TIPS patency in 21 cases (stenoses and occlusions), reduction of TIPS diameters in 9 cases (encephalopathy or deteriorated liver function), embolization of collateral veins due to persistent bleeding (n=3), and 3 patients with TIPS occlusions left untreated.

TIPS procedure using e-PTFE stentgrafts were performed with low peri-procedural mortality and acceptable mid-term patency rates. However, regular follow-up is mandatory to maintain adequate shunt function over time and to perform secondary interventions betimes.

E-PTFE stentgrafts provide acceptable mid-term patency rates and reduce secondary intervention rates compared to previous data using bare-metal-stents.

Koch, U, Kloeckner, R, Schneider, J, Düber, C, Pitton, M, Transjugular Portosystemic Stent Shunts (TIPS) with e-PTFE Stentgrafts in Patients with Refractory Ascites or Acute Variceal Bleeding.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9011264.html