Covered transjugular intrahepatic portosystemic stents maintain lower portal pressure and require fewer reinterventions than uncovered stents.

Background: The purpose of this study was to evaluate the patency, functional and haemodynamic results of expanded-polytetrafluoroethylene (ePTFE)-covered transjugular intrahepatic portosystemic shunts in patients with liver cirrhosis. Methods: Thirteen patients with an ePTFE-covered transjugular intrahepatic portosystemic shunt stent ( TIPSS) were prospectively evaluated at 6 and 12 months and compared with matched controls with mesh-wire uncovered TIPSS. Results: At 6 months, ePTFE-TIPSS showed a significantly lower porto-caval pressure gradient ( PCPG) ( 9 ( 3 - 21) mmHg, P = 0.006), a lower rate of dysfunction (8% versus 54%, P = 0.03) and required fewer reinterventions ( 2 versus 13, P = 0.02); similar results were obtained after 12 months. This resulted in a reduction in the median cost for angiographic surveillance in the covered TIPSS group at 6 and 12 months (36% and 56% compared to the uncovered TIPSS group, P = 0.002), but total procedure-related costs were higher with the ePTFE-TIPSS ( 6 months: 3730 ( 3245 - 6759) versus 1850 ( 1466 - 5479) E/ patient; 12 months: 3945 ( 3460 - 6759) versus 2295 ( 1728 - 5694) E/ patient) due to the higher initial cost of the ePTFE-covered TIPSS. Conclusions: The insertion of ePTFE-covered TIPSS results in better maintenance of lowered portal pressure and fewer reinterventions in patients with liver cirrhosis. There is strong evidence that the use of ePTFE-TIPSS does not require regular surveillance to maintain primary patency, which may then improve cost-effectiveness.