Long-term follow-up of TIPS created with expanded poly-tetrafluoroethylene covered stents.
Long-term follow-up of TIPS created with expanded poly-tetrafluoroethylene covered stents.
复制标题
使用膨胀聚四氟乙烯覆盖支架创建的 TIPS 的长期随访。
DOI：
10.1007/s10620-013-2578-0
复制
发表时间：
2013
影响因子：
3.1
通讯作者：
Rockey,DonC
中科院分区：
文献类型：
--
作者：
Sajja,KrishnaC;Dolmatch,BartL;Rockey,DonC
背景经颈静脉肝内门体分流术（TIPS）已广泛取代裸金属支架。短期分流通畅性通常用多普勒超声（US）方案评估，方法回顾性分析2001年1月至2011年12月期间59例TIPS覆膜支架患者的临床资料。（中位数9天）多普勒超声随访。8例基线US异常的患者中有7例需要支架翻修。46例基线多普勒超声正常的患者在前6个月内均不需要翻修;其中6例患者随后因症状进行了门静脉造影，但所有TIPS均通畅。52例患者存活，进行了长期（>6个月）随访，平均654天和3次多普勒超声检查。6例随访多普勒超声异常的患者中有5例需要翻修，而46例随访超声正常的患者中无一例翻修。门静脉高压症和/或肝性脑病（HE）症状复发率低（4/52例）。未发现长期狭窄的显著预测因素。后TIPS HE是独立的前TIPS HE或Child-Pugh score.ConclusionsShort-term通畅率和大约2年后TIPS安置分别为87和77%。我们得出的结论是，TIPS后至少1周进行多普勒超声是必要的，但在没有临床症状的情况下，重复的多普勒超声随访可能没有必要。
BackgroundTransjugular intrahepatic portosystemic shunts (TIPS) created with expanded poly-tetrafluoroethylene-covered stents have largely replaced bare metal stents. Short-term shunt patency is typically assessed with protocol Doppler ultrasound (US), while little information exists with regard to long-term patency.AimWe investigated the value of Doppler US in assessing TIPS patency as well as long-term clinical outcomes.MethodsA retrospective analysis of 59 patients with covered stents used for TIPS between January 2001 and December 2011 was performed.ResultsFifty-four patients had early (median 9 days) Doppler US follow-up. Seven of eight patients with an abnormal baseline US required stent revisions. None of the 46 patients with normal baseline Doppler US required revisions within the first 6 months; six of these patients subsequently had a portogram because of symptoms, but all TIPS were patent. Fifty-two patients survived for long-term (>6 months) follow-up, averaging 654 days and three Doppler US exams. Five of six patients with abnormal follow-up Doppler US required revisions, whereas none of the 46 patients with normal follow-up US had revisions. The recurrence of symptoms of portal hypertension and/or hepatic encephalopathy (HE) was low (4/52 patients). No significant predictors of long-term stenosis were identified. Post-TIPS HE was independent of pre-TIPS HE or Child-Pugh score.ConclusionsShort-term patency and that at approximately 2 years after TIPS placement was 87 and 77 %, respectively. We conclude that Doppler US at least 1 week after TIPS is warranted, but repeated Doppler US follow-up is probably not necessary in the absence of clinical symptoms.