Long-Term Follow-Up of TIPS Created with Expanded Poly-Tetrafluoroethylene Covered Stents

Abstract

Transjugular intrahepatic portosystemic shunts (TIPS) created with expanded poly-tetrafluoroethylene-covered stents have largely replaced bare metal stents. Short-term shunt patency is typically assessed with protocol Doppler ultrasound (US), while little information exists with regard to long-term patency. We investigated the value of Doppler US in assessing TIPS patency as well as long-term clinical outcomes. A retrospective analysis of 59 patients with covered stents used for TIPS between January 2001 and December 2011 was performed. Fifty-four patients had early (median 9days) Doppler US follow-up. Seven of eight patients with an abnormal baseline US required stent revisions. None of the 46 patients with normal baseline Doppler US required revisions within the first 6months; six of these patients subsequently had a portogram because of symptoms, but all TIPS were patent. Fifty-two patients survived for long-term (>6months) follow-up, averaging 654days and three Doppler US exams. Five of six patients with abnormal follow-up Doppler US required revisions, whereas none of the 46 patients with normal follow-up US had revisions. The recurrence of symptoms of portal hypertension and/or hepatic encephalopathy (HE) was low (4/52 patients). No significant predictors of long-term stenosis were identified. Post-TIPS HE was independent of pre-TIPS HE or Child-Pugh score. Short-term patency and that at approximately 2years after TIPS placement was 87 and 77%, respectively. We conclude that Doppler US at least 1week after TIPS is warranted, but repeated Doppler US follow-up is probably not necessary in the absence of clinical symptoms.