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Long-term outcome of a covered vs. uncovered transjugular intrahepatic portosystemic shunt in Budd–Chiari syndrome

Authors

  • Sarwa Darwish Murad,

    1. Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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  • Trinh K. Luong,

    1. Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
    2. Department of Epidemiology and Biostatistics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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  • Peter M. T. Pattynama,

    1. Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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  • Bettina E. Hansen,

    1. Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
    2. Department of Epidemiology and Biostatistics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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  • Henk R. Van Buuren,

    1. Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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  • Harry L. A. Janssen

    1. Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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Correspondence
Harry L. A. Janssen, MD, PhD, Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Room Ca 326, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
Tel: +31 10 703 5942
Fax: +31 10 436 5916
e-mail: h.janssen@erasmusmc.nl

Abstract

Background: The clinical outcome of a covered vs. uncovered transjugular intrahepatic portosystemic shunt (TIPS) for patients with Budd–Chiari syndrome (BCS) is as yet largely unknown.

Objectives: To compare patency rates of bare and polytetrafluoroethylene (PTFE)-covered stents, and to investigate clinical outcome using four prognostic indices [Child–Pugh score, Rotterdam BCS index, modified Clichy score and Model for End-Stage Liver Disease (MELD)].

Methods: Consecutive patients with BCS who had undergone TIPS between January 1994 and March 2006 were evaluated in a retrospective review in a single centre.

Results: Twenty-three TIPS procedures were performed on 16 patients. The primary patency rate at 2 years was 12% using bare and 56% using covered stents (P=0.09). We found marked clinical improvement at 3 months post-TIPS as determined by a drop in median Child–Pugh score (10–7, P=0.04), Rotterdam BCS index (1.90–0.83, P=0.02) and modified Clichy score (7.77–2.94, P=0.003), but not in MELD (18.91–17.42, P=0.9). Survival at 1 and 3 years post-TIPS was 80% (95% CI: 59–100%) and 72% (95% CI: 48–96%). Four patients (25%) died and one required liver transplantation.

Conclusions: A transjugular intrahepatic portosystemic shunt using PTFE-covered stents shows better patency rates than bare stents in BCS. Moreover, TIPS leads to an improvement in important prognostic indicators for the survival of patients with BCS.

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