Get access

The natural history of parallel transjugular intrahepatic portosystemic stent shunts using uncovered stent: the role of host-related factors

Authors

  • Ahmed Helmy,

    1. Department of Liver Transplantation, King Faisal Specialist Hospital & Research Center; Riyadh, Saudi Arabia,
    Search for more papers by this author
    • *A. H. and A. J. S were formerly affiliated to the Liver Unit, Department of Medicine, Royal Infirmary of Edinburgh, Edinburgh, Scotland.

  • Doris N. Redhead,

    1. Department of Radiology, Royal Infirmary of Edinburgh,
    Search for more papers by this author
  • Adrian J. Stanley,

    1. Department of Gastroenterology, Glasgow Royal Infirmary,
    Search for more papers by this author
    • *A. H. and A. J. S were formerly affiliated to the Liver Unit, Department of Medicine, Royal Infirmary of Edinburgh, Edinburgh, Scotland.

  • Peter C. Hayes

    1. Liver Unit, Department of Medicine, Royal Infirmary of Edinburgh, Scotland
    Search for more papers by this author

Dr. Ahmed Helmy, Department of Liver Transplantation, Hepatobiliary and Pancreatic Surgery, King Faisal Specialist Hospital & Research Center (KFSH&RC), MBC: 72. PO Box: 3354, Riyadh 11211, Saudi Arabia.
e-mail: ahsalem10@hotmail.com

Abstract

Abstract: Objectives: Parallel shunts (PS) are used in the management of transjugular intrahepatic portosystemic stent-shunt (TIPS) insufficiency, a major limitation of the technique. This study describes the natural history of PS, and uses them as a model to assess the role of host factors in the development of primary shunt insufficiency.

Methods: Out of 338 patients with TIPS, 40 (11.8%) patients required insertion of a PS. Baseline and follow-up data of these patients were collected. Regular shunt surveillance involved biannual clinic visits and transjugular portography.

Results: The non-PS group (group 1; n=298) and the PS group (group 2; n=40) had similar baseline demographic and disease characteristics. Index shunts of both groups and the PS produced a significant portal pressure gradient drop (P<0.001), which was less in the index shunts of Group 2 (P<0.02 for both). PS had similar cumulative shunt patency rates to those of the index shunts of Group 1, and both were greater than those of index shunts in Group 2 (P<0.001 for both). The intervention rate (number of interventions/number of check portograms × 100) was similar for PS and the index shunts of Group 1 (38.7% and 43% respectively), but was significantly higher in the index shunts of Group 2 (85.6%; P<0.01 for both). In Group 1 and Group 2, 144 patients (48.3%) and 21 patients (52.5%) died during follow-up after a median period of 23.4 and 8.9 months respectively.

Conclusions: These findings do not support the hypothesis that shunt insufficiency is related to host factors.

Get access to the full text of this article

Ancillary