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. 2018 Jan 9;13(1):e0189414.
doi: 10.1371/journal.pone.0189414. eCollection 2018.

Transjugular intrahepatic portosystemic shunts (TIPS) for the prevention of variceal re-bleeding - A two decades experience

Theresa Bucsics  1   2 , Maria Schoder  3 , Magdalena Diermayr  1   2 , Maria Feldner-Busztin  1   2 , Nicolas Goeschl  1   2 , David Bauer  1   2 , Philipp Schwabl  1   2 , Mattias Mandorfer  1   2 , Bernhard Angermayr  1 , Manfred Cejna  4 , Arnulf Ferlitsch  1   2 , Wolfgang Sieghart  1   2 , Michael Trauner  1 , Markus Peck-Radosavljevic  1   2 , Josef Karner  5 , Franz Karnel  6 , Thomas Reiberger  1   2
Affiliations

Transjugular intrahepatic portosystemic shunts (TIPS) for the prevention of variceal re-bleeding - A two decades experience

Theresa Bucsics et al. PLoS One. .

Abstract

Background and aims: Transjugular intrahepatic portosystemic shunts (TIPS) are used in patients with cirrhosis for the prevention of variceal rebleeding.

Methods: We retrospectively evaluated re-bleeding rate, patency, mortality, and transplant-free survival (TFS) in cirrhotic patients receiving TIPS implantation for variceal bleeding between 1994-2014.

Results: 286 patients received TIPS (n = 119 bare metal stents, n = 167 polytetrafluorethylene (PTFE)-covered stents) for prevention of variceal re-bleeding. Mean age was 55.1 years, median MELD was 11.8, and the main etiology of cirrhosis was alcoholic liver disease (70%). Median follow-up was 821 days. 67 patients (23%) experienced at least one re-bleeding event. Patients with PTFE-TIPS were at significantly lower risk for variceal re-bleeding than patients with bare metal stents (14% vs. 37%, OR:0.259; p<0.001) and had less need for stent revision (21% vs. 37%; p = 0.024). Patients with PTFE stent grafts showed lower mortality than patients with bare stents after 1 year (19% vs. 31%, p = 0.020) and 2 years (29% vs. 40%; p = 0.041) after TIPS implantation. Occurrence of hepatic encephalopathy after TIPS was similar between groups (20% vs. 24%, p = 0.449).

Conclusions: PTFE-TIPS were more effective at preventing variceal re-bleeding than bare metal stents due to better patency. Since this tended to translate in improved survival, only covered stents should be implemented for bleeding prophylaxis when TIPS is indicated.

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Conflict of interest statement

Competing Interests: Franz Karnel (payment for lectures, W.L. GORE & Associates); Mattias Mandorfer (payment for lectures, W.L. GORE & Associates); Thomas Reiberger (payment for lectures, W.L. GORE & Associates); Maria Schoder (payment for lectures, W.L. GORE & Associates).

Figures

Fig 1
Fig 1. Flowchart of patient inclusion.
Abbreviations: TIPS, transjugular intrahepatic portosystemic shunt.
Fig 2
Fig 2. Re-bleeding rates and re-interventions after TIPS implantation.
(A). Rebleeding rates after TIPS implantation. (B). Bleeding recurrence after TIPS implantation, by type of implanted stent.
Fig 3
Fig 3. Transplant-free survival and mortality after TIPS implantation.
(A). Transplant-free survival. (B). Transplant-free survival, by type of implanted stent. (C). Mortality rates at 1 and 2 years, by type of implanted stent.
See this image and copyright information in PMC

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