Transjugular intrahepatic portosystemic shunts (TIPS) are now routinely utilized for the treatment of the complications of cirrhosis-related portal hypertension: indeed TIPS has now a clear indication for active bleeding or to prevent rebleeding after failure of combined medical/ endoscopic procedures; it is also indicated for refractory ascites and, at some extent in refractory hydrothorax in cirrhotic patients and type II hepatorenal syndrome. The initial experience with TIPS was based on the use of bare stents (1,2). These stents were prone to allow intra- stent neointimal proliferation, with the direct consequence of a greater risk of stent dysfunction. The major drawbacks of TIPS are shunt dysfunction and hepatic encephalopathy (HE), reported up to 77% and 50% within the first year (3,4), respectively. The availability of expanded polytetrafluoroethylene (ePTFE)-covered stents has dramatically improved the long-term patency of TIPS but the HE incidence has remained relatively high, ranging from 35–45% at 1 year, even since the advent of covered stents (5,6) and can probably be reduced with a more careful selection of patients. The cost-effectiveness issue of adopting covered (most expensive) and bare stent has been frequently raised but has never been properly addressed. In their recent meta-analysis Qi X et al. (7) compare the outcome of covered versus bare stents for TIPS in cirrhotic patients with portal hypertension. The goals of the meta- analysis were to compare the outcome in term of shunt patency, overall survival and HE when using different stent

Magini, G., Agazzi, R., Fagiuoli, S. (2015). The conundrum of covered versus bare stents for transjugular intrahepatic portosystemic shunt: should we adopt the parachute approach?. AMERICAN MEDICAL JOURNAL, 2(8), 1-4 [10.21037/amj.2017.08.19].

The conundrum of covered versus bare stents for transjugular intrahepatic portosystemic shunt: should we adopt the parachute approach?

Fagiuoli, S
2015

Abstract

Transjugular intrahepatic portosystemic shunts (TIPS) are now routinely utilized for the treatment of the complications of cirrhosis-related portal hypertension: indeed TIPS has now a clear indication for active bleeding or to prevent rebleeding after failure of combined medical/ endoscopic procedures; it is also indicated for refractory ascites and, at some extent in refractory hydrothorax in cirrhotic patients and type II hepatorenal syndrome. The initial experience with TIPS was based on the use of bare stents (1,2). These stents were prone to allow intra- stent neointimal proliferation, with the direct consequence of a greater risk of stent dysfunction. The major drawbacks of TIPS are shunt dysfunction and hepatic encephalopathy (HE), reported up to 77% and 50% within the first year (3,4), respectively. The availability of expanded polytetrafluoroethylene (ePTFE)-covered stents has dramatically improved the long-term patency of TIPS but the HE incidence has remained relatively high, ranging from 35–45% at 1 year, even since the advent of covered stents (5,6) and can probably be reduced with a more careful selection of patients. The cost-effectiveness issue of adopting covered (most expensive) and bare stent has been frequently raised but has never been properly addressed. In their recent meta-analysis Qi X et al. (7) compare the outcome of covered versus bare stents for TIPS in cirrhotic patients with portal hypertension. The goals of the meta- analysis were to compare the outcome in term of shunt patency, overall survival and HE when using different stent
Articolo in rivista - Articolo scientifico
bare stents, transjugular intrahepatic portosystemic shunt;
English
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Magini, G., Agazzi, R., Fagiuoli, S. (2015). The conundrum of covered versus bare stents for transjugular intrahepatic portosystemic shunt: should we adopt the parachute approach?. AMERICAN MEDICAL JOURNAL, 2(8), 1-4 [10.21037/amj.2017.08.19].
Magini, G; Agazzi, R; Fagiuoli, S
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/353447
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