Retrospective comparison of the patency of wallstents and Palmaz long-medium stents used for TIPS

Purpose: To compare patency rates of transjugular intrahepatic portosystemi c shunts (TIPS) after placement of long-medium Palmaz stents or Wallstents. Methods: We performed a retrospective review of TIPS performed at our insti tution between December 1997 and December 1998. During this time period we placed long-medium Palmaz stents for TIPS procedures in 17 patients and Wal lstents in 20 patients as the initial stent. Patency was determined on foll ow-up by ultrasound, angiography, or pathologic examination in the event of transplant. Results: Primary patency in the Palmaz stent group was 70.6% (12/17 patient s) (follow-up 1-399 days, mean 127 days). Both primary assisted and seconda ry patency in the Palmaz group was 100% (17/17 patients) (follow up 1-399 d ays, mean 154 days). Primary patency in the Wallstent group was 50% (10/20 patients) (follow up 1-370 days, mean 65 days). Primary assisted patency in the Wallstent group was 80% (16/20 patients) (follow up 1-601 days, mean 1 41 days). Secondary patency in the Wallstent group was 100% (20/20 patients ) (follow up 2-601 days, mean 142 days). Kaplan-Meier analysis of the two g roups of patients yielded a primary patency of 266 days (standard error 45 bays) for TIPS with the Palmaz stent and 139 days (standard error 45 days) for the Wallstent (p = .04). The 3, 6, and 12-month primary patency rates w ere .84, .63, and .18 respectively for the Palmaz stents and .36, .36, and .18 respectively for the Wallstent. Then was no significant difference in p rimary assisted or secondary patency between the two stent groups. The mean tract curvature in the patients with Palmaz stents was 23.5 degrees (SD 18 .2 degrees, range 0-69.0 degrees) compared with 57 degrees (SD 34.5 degrees , range 7.0-144.0 degrees) in patients with Wallstents (p = .01). Conclusions: Our nonprospective, nonrandomized study suggests that TIPS cre ated with the long-medium Palmaz stent have a higher primary patency than t hose created with the Wallstent in tracts that rue relatively straight.