• Academic radiology · Jul 2018

    Predictors of Shunt Dysfunction and Overall Survival in Patients with Variceal Bleeding Treated with Transjugular Portosystemic Shunt Creation Using the Fluency Stent Graft.

    • Yue-Meng Wan, Yu-Hua Li, Ying Xu, Hua-Mei Wu, Ying-Chun Li, Xi-Nan Wu, and Jin-Hui Yang.
    • Gastroenterology Department II or Hepatology Center, The 2nd Affiliated Hospital of Kunming Medical University, Dianmian Avenue, No 374, Kunming City, Yunnan Province, 650101, China; Public Health Institute of Kunming Medical University, Kunming city, China.
    • Acad Radiol. 2018 Jul 1; 25 (7): 925-934.

    Rationale And ObjectivesTransjugular intrahepatic portosystemic shunt (TIPS) is an established method for portal hypertension. This study was to investigate the long-term safety, technical success, and patency of TIPS, and to determine the risk factors and clinical impacts of shunt dysfunction.Materials And MethodsA total of 154 consecutive patients undergoing embolotherapy of gastric coronary vein and/or short gastric vein and TIPS creation were prospectively studied. Follow-up data included technical success, patency and revision of TIPS, and overall survival of patients.ResultsDuring the study, the primary and secondary technical success rates were 98.7% and 100%, respectively. Sixty-three patients developed shunt dysfunction, 30 with shunt stenosis and 33 with shunt occlusion. The cumulative 60-month primary, primary assisted, and secondary patency rates were 19.6%, 43.0%, and 93.4%, respectively. The cumulative 60-month overall survival rates were similar between the TIPS dysfunction group and the TIPS non-dysfunction group (68.6% vs. 58.6%, P = .096). Baseline portal vein thrombosis (P < .001), use of bare stents (P = .018), and portal pressure gradient (PPG) (P = .020) were independent predictors for shunt dysfunction, hepatocellular carcinoma (P < .001), and ascites (P = .003) for overall survival. The accuracy of PPG for shunt dysfunction was statistically significant (P < .001), and a cutoff value of 8.5 had 77.8% sensitivity and 64.8% specificity.ConclusionsThe long-term safety, technical success, and patency of TIPS were good; baseline portal vein thrombosis, use of bare stents, and PPG were significantly associated with shunt dysfunction; shunt dysfunction has little impact on patients' long-term survival because of high secondary patency rates.Copyright © 2018 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

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