Reply to “Viatorr TIPS Endoprosthesis Versus Generic Expanded Polytetrafluoroethylene–Covered Stent-Grafts”

Abstract

AJR 2015; 205:W1 0361–803X/14/2054–W1 © American Roentgen Ray Society Reply to “Viatorr TIPS Endoprosthesis Versus Generic Expanded ­Polytetrafluoroethylene–Covered Stent-Grafts” We agree with Dr. Tsauo and Dr. Li [1] that there is a lack of comparative data on the different types of expanded polytetrafluoroethylene (ePTFE)–covered stent-grafts available for use in transjugular intrahepatic portosystemic shunt (TIPS) procedures. As they discussed, the Fluency Plus (Bard Peripheral Vascular) ePTFE-covered stent-graft has slightly flared and uncovered 37-mm ends on both sides of the stent-graft. In the United States, the stent-graft is indicated for use in stent-restenotic lesions in arteriovenous fistulas and grafts. In contrast, the Viatorr TIPS Endoprosthesis (W. L. Gore & Associates) has a direct indication for TIPS and contains a 2-cm uncovered bare metal portion that can be deployed along the portal aspect of the shunt. Both are self-expanding stent-grafts. The 1-year primary unassisted patency rate has been reported to be 81% versus 89% for the Fluency Plus and Viatorr TIPS Endoprosthesis stent-grafts, respectively. No statistically significant differences were found in the major encephalopathy or hemodynamic success rates of TIPS. Saad et al. [2] used a technique in which a bare metal stent was used along the portal end, in combination with a Fluency Plus stent-graft, instead of relying on the short bare metal flared end of the stent-graft. In comparison, the Viatorr TIPS Endoprosthesis is often deployed as a single stent-graft. Thus, future cost-effectiveness studies should address comparisons of technique, including the number of stents and stent-grafts used, and should not simply compare the two stent-grafts alone. Fluency Plus stent-grafts are likely effective for use in TIPS [3] and may have increased efficacy when compared with other polymer stent-grafts [4]. Fluency Plus stentgrafts may represent an alternative in areas where Viatorr TIPS stent-grafts are unavailable; however, the limitations of Fluency Plus, as used in the United States, include absence of an indication for TIPS, lack of comparative data, and uncertain cost-effectiveness. Zachary L. Bercu Icahn School of Medicine at Mount Sinai, New York, NY Present address: Emory University School of Medicine, Atlanta, GA Aaron M. Fischman Robert A. Lookstein Icahn School of Medicine at Mount Sinai, New York, NY DOI:10.2214/AJR.15.14822 WEB—This is a web exclusive article.