Abstract
Purpose To evaluate the technical, anatomical, functional and clinical outcomes of transjugular intrahepatic portosystemic shunts (TIPS) based on the portal venous entry site of TIPS. Materials and Methods 158 TIPS placements (100 men; median age, 57 years; range, 24-79 years) were divided into: Segmental branch access (distal to the right or left portal trunks) and nonsegmental branch access (portal bifurcation, right or left portal trunks). Risk factors for recurrence of symptoms and TIPS revision required were analyzed using multivariate cox proportional hazards analyses. The rates of recurrence of symptoms, TIPS revision, primary unassisted stent patency, transplant-free survival, and worsening of encephalopathy, were analyzed using Kaplan-Meier method, and significance were determined with log-rank tests among the derived risk factors. Results There were 54 TIPS with segmental and 104 with non-segmental branch accesses (all created utilizing one type of stent-graft). Falling short of the hepatocaval junction was statistically not significant for both groups (P = .166). Recurrence of symptoms was observed in 39 (25%) placements, and TIPS revision was required in 33 (21%) placements. Multivariate analyses for recurrence of symptoms showed younger age (P = .002) and segmental branch access of the right portal vein (P = .038) were significant risk factors. For TIPS revision, segmental branch access (P = .034) was the only significant risk factors. TIPS patency with segmental branch access was significantly lower than that in non-segmental branch access (35% vs. 76% at 2-years, respectively; P = .005). No significant differences in transplant-free survival (P = .323), worsening of encephalopathy (P = .574), and major complications (P = 1.000), were observed between segmental and non-segmental accesses. Conclusion TIPS created utilizing stent-grafts with segmental portal venous branch access have inferior patency and functional outcomes compared to TIPS with portal trunk (right or left portal vein trunk) or portal bifurcation access. However, this does not translate to a reduction in patient survival.
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