Transjugular intrahepatic portosystemic shunts (TIPS) for the prevention of variceal rebleeding – A two decades experience

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

Research output: Article

7 Citations (Scopus)

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 rebleeding event. Patients with PTFE-TIPS were at significantly lower risk for variceal rebleeding 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.

Original languageEnglish
Article numbere0189414
JournalPloS one
Volume13
Issue number1
DOIs
Publication statusPublished - jan. 2018

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

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    Bucsics, T., Schoder, M., Diermayr, M., Feldner-Busztin, M., Goeschl, N., Bauer, D., Schwabl, P., Mandorfer, M., Angermayr, B., Cejna, M., Ferlitsch, A., Sieghart, W., Trauner, M., Peck-Radosavljevic, M., Karner, J., Karnel, F., & Reiberger, T. (2018). Transjugular intrahepatic portosystemic shunts (TIPS) for the prevention of variceal rebleeding – A two decades experience. PloS one, 13(1), [e0189414]. https://doi.org/10.1371/journal.pone.0189414