TIPS geometry influences patency

Abstract

Objective: The purpose of this study was to evaluate potential causes of Transjugular intrahepatic portosystemic shunt (TIPS) dysfunction.

Material and Methods: We retrospectively evaluated 26 patients who required TIPS revision (group I) and 24 patients who did not require any further intervention (group II) within the first two years following TIPS implantation. The distance of the distal end of the stent to the hepatocaval junction was measured. Furthermore, the angle between the stent and the portal vein (inflow) and the angle between the stent and the hepatic vein (outflow) were measured. Furthermore, the following data were evaluated: pre- and postinterventional portal pressure gradients, maximal postinterventional flow and blood values [C-reactive protein (CRP), bilirubin, glutamic-oxaloacetic transaminase (GOT), glutamic-pyruvic transaminase (GPT)].

Results: Compared with control subjects, patients who required TIPS revision showed a significantly longer distance from the distal end of the stent to the hepatocaval junction (I: 17.3 ± 10 mm, II: 6.7 ± 5.7 mm, p < 0.001). There was a statistically significant correlation between the above named distance and the time to revision (Pearson’s correlation coefficient, r = 0.5, p = 0.01). In addition, patients with TIPS revision had a significantly larger angle of portalvenous inflow (alpha angle) than the control group (I: 100.5 ± 31.5°, II: 64.5 ± 31.6°, p < 0.001).

Conclusion: Our results show that the distance from the end of the stent to the hepatocaval junction and the angle of portalvenous inflow are technical factors that may influence the shunt’s patency rate. Of these two, the distance to the hepatocaval junction can be influenced easily by the interventionalist.

Zusammenfassung

Ziel: Das Ziel dieser Studie war es, potenzielle Ursachen der TIPS-Dysfunktion zu evaluieren.

Material und Methoden: Wir haben retrospektiv die Daten von 26 Patienten ausgewertet, die innerhalb von 2 Jahren einer TIPS-Revision (Gruppe I) zugeführt wurden und von 24 Patienten, bei denen in den ersten 2 Jahren nach der TIPS-Implantation (Gruppe II) keine weitere Intervention nötig war. Es wurde die Distanz zwischen dem distalen Stentende und dem Lebervenenstern gemessen. Außerdem wurde der Winkel der Blutflussauslenkung am portalvenösen Einstrom und am zentralvenösen Ausstrom bestimmt. Zudem wurden die folgenden Daten bewertet: prä- und postinterventionelle Pfortaderdruckgradienten, maximaler postinterventioneller Blutfluss und Blutwerte [C-reaktives Protein (CRP), Bilirubin, Glutamat-Oxaloacetat-Transaminase (GOT), Glutamat-Pyruvat-Transaminase (GPT)].

Ergebnisse: Im Vergleich zur Kontrollgruppe ließ sich bei den Patienten mit einer TIPS-Revision ein signifikant größerer Abstand zwischen dem distalen Stentende und dem Lebervenenstern nachweisen (I: 17,3 ± 10 mm, II: 6,7 ± 5.7 mm, p < 0,001). Es zeigte sich eine statistisch signifikante Korrelation zwischen dem Abstand und der Zeit zur Revision (Pearson’s Korrelationskoeffizient, r = 0,5, p = 0,01). Zudem bestand bei den Patienten mit der TIPS-Revision ein signifikant größerer Winkel der Blutflussauslenkung am portalvenösen Einstrom (Alpha-Winkel) als in der Kontrollgruppe (I: 100,5 ± 31.5°, II: 64,5 ± 31,6°, p < 0,001).

Schlussfolgerung: Unsere Ergebnisse zeigen, dass die Distanz zwischen dem distalen Stentende und dem Lebervenenstern sowie der Winkel der Blutflussauslenkung am portalvenösen Einstrom technische Faktoren sind, die die Offenheitsrate des TIPS beeinflussen können. Dabei kann der Abstand des Stents zum Lebervenenstern leicht durch den Interventionalisten beeinflusst werden.

Schlüsselwörter

Autoimmunhepatitis - Virushepatitis - Leber

Key words

autoimmune hepatitis - viral hepatitis - liver

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