Universität zu Köln

Trebicka, Jonel ORCID: 0000-0002-7028-3881, Bastgen, Diana, Byrtus, Jonathan, Praktiknjo, Michael, Terstiegen, Sophia, Meyer, Carsten, Thomas, Daniel, Fimmers, Rolf, Treitl, Markus, Euringer, Wulf, Sauerbruch, Tilman and Roessle, Martin (2019). Smaller-Diameter Covered Transjugular Intrahepatic Portosystemic Shunt Stents Are Associated With Increased Survival. Clin. Gastroenterol. Hepatol., 17 (13). S. 2793 - 2801. NEW YORK: ELSEVIER SCIENCE INC. ISSN 1542-7714

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Abstract

BACKGROUND & AIMS: We studied the effects of diameter of covered, self-expandable, nitinol stents on survival times of patients with a transjugular intrahepatic portosystemic shunt (TIPS). METHODS: We collected data from 185 patients (median age, 55 y; 30% female) who received a covered nitinol stent, from February 2006 through September 2010, using the online multicenter German TIPS registry. TIPS were given to 107 patients for refractory ascites and to 78 patients for variceal bleeding. Patients at risk of hepatic encephalopathy (owing to advanced age, prior episodes) or liver failure (bilirubin level, >3 mg/dL), and bleeding patients receiving variceal embolization at TIPS, received 8-mm stents (n = 53). The remaining patients received 10-mm stents (n = 132). Eighty-one of the 10-mm stents were underdilated using 8-mm dilation balloons. Clinical and biochemical data were collected after TIPS placement at 1 month, 3 months, 6 months, 9 months, 1 year, and thereafter every 3 to 6 months. Groups were compared using propensity score analysis. RESULTS: Patients who received 8-mm stents survived significantly longer (34 +/- 26 mo) than patients who received 10-mm stents (18 +/- 19 mo), regardless of whether they were fully dilated or underdilated. When we compared 10-mm stents with or without underdilation, we found that a significantly higher proportion of patients who received underdilated stents survived for 1 month after TIPS placement (95% vs 84%; P = .03), but not for 3 months (P = .10). In multivariate analysis, 1-year mortality correlated with full dilation of the stent to 10 mm (hazard ratio [HR], 2.0; 95% CI, 1.1-3.5) and with serum creatinine concentration at baseline (HR, 1.5; 95% CI, 1.0-1.7). Five-year mortality was associated with use of the 10-mm stents (HR, 1.8; 95% CI, 1.4-2.7) and baseline concentration of creatinine (HR, 1.3; 95% CI, 1.1-1.6). CONCLUSIONS: A smaller stent (nominal diameter of 8 mm, but not underdilation of a 10-mm stent) is associated with a prolonged survival compared with 10-mm stents, independent of liver-specific prognostic criteria.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Trebicka, Jonel UNSPECIFIED orcid.org/0000-0002-7028-3881 UNSPECIFIED Bastgen, Diana UNSPECIFIED UNSPECIFIED UNSPECIFIED Byrtus, Jonathan UNSPECIFIED UNSPECIFIED UNSPECIFIED Praktiknjo, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Terstiegen, Sophia UNSPECIFIED UNSPECIFIED UNSPECIFIED Meyer, Carsten UNSPECIFIED UNSPECIFIED UNSPECIFIED Thomas, Daniel UNSPECIFIED UNSPECIFIED UNSPECIFIED Fimmers, Rolf UNSPECIFIED UNSPECIFIED UNSPECIFIED Treitl, Markus UNSPECIFIED UNSPECIFIED UNSPECIFIED Euringer, Wulf UNSPECIFIED UNSPECIFIED UNSPECIFIED Sauerbruch, Tilman UNSPECIFIED UNSPECIFIED UNSPECIFIED Roessle, Martin UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-126348
DOI:	10.1016/j.cgh.2019.03.042
Journal or Publication Title:	Clin. Gastroenterol. Hepatol.
Volume:	17
Number:	13
Page Range:	S. 2793 - 2801
Date:	2019
Publisher:	ELSEVIER SCIENCE INC
Place of Publication:	NEW YORK
ISSN:	1542-7714
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language PORTAL PRESSURE-GRADIENT; PASSIVE EXPANSION; HEPATIC-ENCEPHALOPATHY; TIPS; CIRRHOSIS; POLYTETRAFLUOROETHYLENE; PREVENTION; CONSENSUS; VEIN Multiple languages Gastroenterology & Hepatology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/12634