3:45 PM Abstract No. 252 Retrospective review of the safety and efficacy of 12-mm-diameter PTFE-covered stents in transjugular intrahepatic portosystemic shunt creation: a single institution’s experience

Abstract

The objective of this study is to evaluate the efficacy, complications, and 30-day mortality of transjugular intrahepatic portosystemic shunt (TIPS) creation performed using 12 mm internal diameter polytetrafluoroethylene (PTFE)-covered stents in patients with portal hypertension and variceal hemorrhage. We retrospectively reviewed the medical records of 27 patients who underwent transjugular intrahepatic porsosytemic shunt (TIPS) creation from March of 2014 to December of 2016, using 12 mm PTFE covered stents (VIATORR, Gore Medical, AZ) for variceal hemorrhage. Patient demographics, porto-systemic gradients, clinical follow-up, including rate of variceal hemorrhage and hepatic encephalopathy were reviewed. A total of 27 patients were identified (mean age, 50.5 years [± 9.2]; 17 male). Of the 27 patients, 2 were lost to follow-up. Most common underlying etiologies of cirrhosis were alcohol use (41%), HCV (19%), and non-alcoholic steatohepatitis (NASH, 19%). Other etiologies included autoimmune hepatitis, primary biliary cirrhosis, and Budd-Chiari syndrome. The mean portosystemic gradient before TIPS was 18.5 mm Hg (± 8.9, CI 15.0 – 22.1). Mean portosystemic gradient after TIPS was 4.1 mm Hg (± 2.6, CI 3.2–5.1). During a mean follow-up period of 35 months, rate of recurrent variceal hemorrhage was 4.5% (1 of 22 patients). Rate of new-onset hepatic encephalopathy after TIPS was 34% (9 of 24 patients). 30-day post procedure mortality rate was 15% (4 of 27 patients). Three of the four deaths were a result of cardiac arrest, which happened prior to TIPS deployment in an emergent setting. No instances of repeat intervention were recorded in the follow-up period. The placement of a 12 mm PTFE-covered stent during TIPS creation in cirrhotic patients with variceal bleeding appears more efficacious without increased complication rate compared to published literature for 8 and 10 mm diameter stents.