Comparison study of Doppler ultrasound surveillance of expanded polytetrafluoroethylene‐covered stent versus bare stent in transjugular intrahepatic portosystemic shunt

Abstract

Objective. This prospectively randomized controlled study aimed to assess with Doppler ultrasound (US) the shunt function of expanded polytetrafluoroethylene (ePTFE)‐covered transjugular intrahepatic portosystemic shunt (TIPS) stent versus bare stent and to evaluate the usefulness of routine TIPS follow‐up of ePTFE‐covered stents. Methods. Sixty consecutive patients were randomized for bare or covered transjugular TIPS stenting in our institution between April 2007 and April 2009. Data of follow‐up Doppler US, angiography, and portosystemic pressure gradient measurements were collected and analyzed. Results. The follow‐up period was 8.34 ± 4.42 months in the bare‐stent group and 6.16 ± 3.89 months in the covered‐stent group. Baseline clinical characteristics were similar in both groups. Two hundred three US studies were performed in 60 patients, with a mean of 3.4 per patient, and demonstrated abnormalities in 28 patients (21 bare stents, 7 ePTFE‐covered stents), 19 of them (13 in bare‐stent group, 6 in covered‐stent group) showing no clinical evidence of recurrence. Ten of 13 patients in the bare‐stent group underwent balloon angioplasty or additional stent placement, whereas only one of six patients in the covered‐stent group needed reintervention for intimal hyperplasia. The average peak velocity in the midshunt of ePTFE‐covered stent was 139 ± 26 cm/s after TIPS creation and 125 ± 20 cm/s during follow‐up, which was significantly higher than the bare‐stent group (p < 0.05). The main portal vein and hepatic artery showed higher flow velocities in the ePTFE‐covered stent group than in the bare‐stent group. ePTFE‐covered stents maintained lower portosystemic pressure gradient than bare stents (9.5 ± 2.9 versus 13.2 ± 1.5 mmHg, p < 0.05). Conclusions. ePTFE‐covered stents resulted in higher patency rates and better hemodynamics than bare stents. Routine US surveillance may not be necessary in patients with ePTFE‐covered TIPS stent. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound 38:353‐360, 2010