Clinical Efficacy of Transjugular Intrahepatic Portosystemic Shunt Created with Expanded Polytetrafluoroethylene-Covered Stent-Grafts: 8-mm Versus 10-mm

Purpose Conflicting data exist regarding the appropriate shunt diameter for transjugular intrahepatic portosystemic shunt (TIPS) creation in cirrhotic patients. This study was designed to compare the clinical efficacy of TIPS using stent-grafts with 8- and 10-mm diameters. Methods In this retrospective study, cirrhotic patients who underwent TIPS technical successfully for the prevention of variceal rebleeding from December 2011 to June 2015 were included. Thirty-four patients with 8-mm TIPS and 380 patients with 10-mm TIPS were identified. Propensity score matching method produced 32 patients in each group for comparison. Results Baseline characteristics between two groups were comparable. There was no significant difference in variceal rebleeding rate between the two groups. The cumulative incidence of variceal rebleeding after 1 and 3 years was 6.4% and 35.5% in the 8-mm group, respectively, and 14.2% and 24.9% in the 10-mm group, respectively ( P = 0.663). 8-mm TIPS conferred a significant decrease in hepatic encephalopathy (HE) rate compared with the 10-mm TIPS (16.1 vs. 32.6% at 1 year, 27.8 vs. 53.2% at 3 years, P = 0.034). The cumulative survival rates were similar between the two groups: 93.3% and 79.6% at 1 and 3 years, respectively, in the 8-mm TIPS group vs. 87.3% and 72.1% at 1 and 3 years, respectively, in the 10-mm TIPS group ( P = 0.451). Conclusion The placement of 8-mm TIPS was sufficient to decompress the portal hypertension and prevent variceal rebleeding. The use of the 8-mm stent-graft can decrease HE rates compared with 10-mm stent-graft, although no survival benefit was observed.