Charles N. Weber MD, Presenter: Nothing to Disclose

Gregory Jon Nadolski MD, Abstract Co-Author: Nothing to Disclose

Michael Christopher Soulen MD, Abstract Co-Author: Royalties, Cambridge University Press Consultant, Guerbet SA Research support, Guerbet SA Consultant, BTG International Ltd Research support, BTG International Ltd Consultant, Merit Medical Systems, Inc Speaker, Sirtex Medical Ltd

Distance from the hepatocaval junction (HCJ) to the hepatic venous (HV) end of transjugular intrahepatic portosystemic shunt (TIPS) created with bare metal stents (BMS) has been shown to impact patency. Now, most TIPS are created with polytetrafluoroethylene (PTFE)-covered stent-grafts. Our study investigates the impact of distance from the HCJ on long-term patency of PTFE-covered TIPS.

PTFE-covered TIPS placed between 2002 and 2013 were retrospectively reviewed. Clinical and imaging data were collected from the electronic medical record and radiology imaging archive. Distance from HV end to the HCJ was recorded. Primary patency rates were calculated. Differences between groups based on distance from HV end to HCJ were compared using Kaplan-Meier and Cox regression analyses.

300 PTFE-covered TIPS were included in the study. 201 were placed with a single stent-graft while 99 were extended at the HV end with additional BMS (N=70) or PTFE stent-grafts (N=29). No threshold distance between HV end of the TIPS and HCJ was found to impact long-term patency (p-values at thresholds of 0, 5, 10, 15, and 20 mm were 0.92, 0.79, 0.43, 0.36 and 0.24 respectively). Primary patency in TIPS placed with just a single stent-graft versus those using additional stents was 83% vs 71% and 81% vs 60% at 1 and 2 years respectively (p = 0.03). In TIPS created with multiple stents, primary patency of those with BMS versus PTFE-covered extensions was 73% vs 69% and 69% vs 46% at 1 and 2 years respectively (p = 0.28). Regression analysis demonstrated the length by which a TIPS was extended and the final distance of the HV end to the HCJ were not predictors of patency failure (p > 0.1 and p = 0.06 respectively).

If the HV end of PTFE-covered TIPS is within 2 cm of the HCJ, the primary patency is not determined by the actual distance from the HCJ nor is it improved by extending the TIPS to the HCJ. If extended, PTFE-covered extensions offer no patency benefit over BMS. The best patency rates occur with single PTFE-covered TIPS.

For PTFE-covered TIPS placed within 2 cm of the HCJ, there is no additional benefit of further shunt extension, potentially reducing added procedure time and cost.

Weber, C, Nadolski, G, Soulen, M, Impact of Stent-graft Position on Patency of PTFE-covered TIPS.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14009511.html