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Hayek G, Ronot M, Plessier A, Sibert A, Abdel-Rehim M, Zappa M, Rautou PE, Valla D, Vilgrain V. Long-term Outcome and Analysis of Dysfunction of Transjugular Intrahepatic Portosystemic Shunt Placement in Chronic Primary Budd-Chiari Syndrome. Radiology 2016; 283:280-292. [PMID: 27797679 DOI: 10.1148/radiol.2016152641] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Purpose To evaluate the long-term safety, technical success, and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in a series of patients with Budd-Chiari syndrome (BCS), and to determine the predictors of shunt dysfunction. Materials and Methods From 2004 to 2013, all patients with primary BCS referred for TIPS placement were included in the study. The primary and secondary technical success rates and the number and types of early (ie, before day 7) complications were noted. Factors associated with dysfunction were analyzed with uni- and multivariate analyses. Survival was analyzed with Kaplan-Meier curves. Results Fifty-four patients (34 women [63%]; mean age, 36 years ± 12 [standard deviation]) were included. Twenty-eight patients (52%) had myeloproliferative neoplasms. The mean Model for End-Stage Liver Disease score was 14.5 ± 4. The most frequent indication for TIPS was refractory ascites (50 of 54; 93%). Primary and secondary technical success rates were 93% and 98%, respectively. Early complications occurred in 17 patients (32%). After a mean follow-up of 56 months ± 41 (interquartile range, 22-92), 22 patients (42%) experienced at least one episode of TIPS dysfunction (median delay between administration of TIPS and first episode of dysfunction, 10.8 months). Cumulative 1-, 2-, 3-, 5-, and 10-year primary patency rates were 64%, 59%, 54%, 45%, and 45%, respectively. Dysfunction was associated with a myeloproliferative neoplasm (hazard ratio, 8.18; 95% confidence interval: 1.45, 46.18; P = .017), more than two initial stents (hazard ratio, 3.90; 95% confidence interval:1.16, 13.10; P = .027), and the occurrence of early complications (hazard ratio, 11.34; 95% confidence interval: 1.82, 70.69; P = .009). The 10-year survival rate was 76%. Conclusion TIPS placement in patients with chronic primary BCS was associated with a nonnegligible rate of early complications and required endovascular revision or revisions in 42% of patients. Nevertheless, secondary patency was close to 100%, and long-term survival was good. © RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Georges Hayek
- From the Departments of Radiology (G.H., M.R., A.S., M.A.R., M.Z., V.V.) and Hepatology (A.P., P.E.R., D.V.), APHP, University Hospitals Paris Nord Val de Seine, Beaujon Hospital, 100 Boulevard du Général Leclerc, 92118 Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France (M.R., P.E.R., D.V., V.V.); and INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France (M.R., V.V.)
| | - Maxime Ronot
- From the Departments of Radiology (G.H., M.R., A.S., M.A.R., M.Z., V.V.) and Hepatology (A.P., P.E.R., D.V.), APHP, University Hospitals Paris Nord Val de Seine, Beaujon Hospital, 100 Boulevard du Général Leclerc, 92118 Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France (M.R., P.E.R., D.V., V.V.); and INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France (M.R., V.V.)
| | - Aurélie Plessier
- From the Departments of Radiology (G.H., M.R., A.S., M.A.R., M.Z., V.V.) and Hepatology (A.P., P.E.R., D.V.), APHP, University Hospitals Paris Nord Val de Seine, Beaujon Hospital, 100 Boulevard du Général Leclerc, 92118 Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France (M.R., P.E.R., D.V., V.V.); and INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France (M.R., V.V.)
| | - Annie Sibert
- From the Departments of Radiology (G.H., M.R., A.S., M.A.R., M.Z., V.V.) and Hepatology (A.P., P.E.R., D.V.), APHP, University Hospitals Paris Nord Val de Seine, Beaujon Hospital, 100 Boulevard du Général Leclerc, 92118 Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France (M.R., P.E.R., D.V., V.V.); and INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France (M.R., V.V.)
| | - Mohamed Abdel-Rehim
- From the Departments of Radiology (G.H., M.R., A.S., M.A.R., M.Z., V.V.) and Hepatology (A.P., P.E.R., D.V.), APHP, University Hospitals Paris Nord Val de Seine, Beaujon Hospital, 100 Boulevard du Général Leclerc, 92118 Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France (M.R., P.E.R., D.V., V.V.); and INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France (M.R., V.V.)
| | - Magaly Zappa
- From the Departments of Radiology (G.H., M.R., A.S., M.A.R., M.Z., V.V.) and Hepatology (A.P., P.E.R., D.V.), APHP, University Hospitals Paris Nord Val de Seine, Beaujon Hospital, 100 Boulevard du Général Leclerc, 92118 Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France (M.R., P.E.R., D.V., V.V.); and INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France (M.R., V.V.)
| | - Pierre-Emmanuel Rautou
- From the Departments of Radiology (G.H., M.R., A.S., M.A.R., M.Z., V.V.) and Hepatology (A.P., P.E.R., D.V.), APHP, University Hospitals Paris Nord Val de Seine, Beaujon Hospital, 100 Boulevard du Général Leclerc, 92118 Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France (M.R., P.E.R., D.V., V.V.); and INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France (M.R., V.V.)
| | - Dominique Valla
- From the Departments of Radiology (G.H., M.R., A.S., M.A.R., M.Z., V.V.) and Hepatology (A.P., P.E.R., D.V.), APHP, University Hospitals Paris Nord Val de Seine, Beaujon Hospital, 100 Boulevard du Général Leclerc, 92118 Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France (M.R., P.E.R., D.V., V.V.); and INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France (M.R., V.V.)
| | - Valérie Vilgrain
- From the Departments of Radiology (G.H., M.R., A.S., M.A.R., M.Z., V.V.) and Hepatology (A.P., P.E.R., D.V.), APHP, University Hospitals Paris Nord Val de Seine, Beaujon Hospital, 100 Boulevard du Général Leclerc, 92118 Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France (M.R., P.E.R., D.V., V.V.); and INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France (M.R., V.V.)
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