A comparison of clinical efficacy between covered stent-grafts and bare stents in transjuglar in-trahepatic portosystemic shunt / 中华放射学杂志

ABSTRACT

Objective To compare the clinical efficacy between covered stent and uncovered stent in transjuglar in-trahepatic portosystemic shunt (TIPS) .Methods Thirty patients with liver cirrhosis (portal hypertension), who received TIPS, were retrospectively studied.All patients were divided into two groups covered-stent group(n =20) and uncovered-stent group (n=10).For each patient, portal pressure was measured before and after operation, and the patency of shunt was evaluated by color Doppler ultrasound after operation.The mortality, recurrent bleeding rate and incidence of hepatic encephalopathy were analyzed by Fisher exact probability test.Results The TIPS treatment was successful in all patients, the portal pressure in the covered-stent group reduced from (3.78±0.50) kPa before operation to (2.21±0.44) kPa and that of the uncovered-stent group reduced from (3.67±0.48) kPa to (2.13±0.35) kPa.Twenty-six cases were postoperatively followed-up (17 cases in covered-stent group, 9 cases in uncovered-stent group).The follow-up period varied from 7 days to 62 months (median follow-up period was 23 months).Thirteen patients died of upper gastrointestinal bleeding and hepatic failure.The difference of mortality between covered-stent group (8/17) and uncovered-stent group (5/9) did not reach significant (P>0.05).The recurrent bleeding rate between the covered-stent group (5/17) and the uncovered-stent group (3/9) was not different too (P>0.05).The incidence of hepatic encephalopathy in the covered-stent group (4/17) was not different from that of the uncovered-stent group (2/9) (P> 0.05).The patency rates of 6 months and 12 months reached 100% in the covered-stent group, which were higher than those in the uncovered- stent group 77.8% (7/9) and 55.6% (5/9) (P<0.05) .Conclusions The patency rate of shunt at 12 months after TIPS was higher in the covered-stent group than the uncovered-stent group, while the mortality, recurrent bleeding rate and incidence of hepatic encephalopathy were not significantly different between the two groups.