Abstract
Complications of portal hypertension can be treated with transjugular intrahepatic portosystemic shunt (TIPS) in selected patients. TIPS dysfunction is a relevant clinical problem. This study investigated the prognostic value of two-dimensional (2D) TIPS geometry for the development of TIPS dysfunction. Three hundred and seven patients undergoing TIPS procedure between 2014 and 2019 were analyzed in this monocentric retrospective study. 2D angiograms from the patients with and without TIPS dysfunction were reviewed to determine geometric characteristics including insertion and curve angles and the location of the stent. Primary outcome was the development of TIPS dysfunction. A total of 70 patients developed TIPS dysfunction and were compared to the dysfunction-free (n = 237) patients. The position of the cranial stent end in the hepatic vein and the persistence of spontaneous portosystemic shunts were significantly associated with the development of TIPS dysfunction. Among significant parameters in univariable regression analysis (portal vein-pressure after TIPS, Child–Pugh Score before TIPS, MELD before TIPS and white blood cell count before TIPS), multivariable models showed cranial stent position (p = 0.027, HR 2.300, 95% CI 1.101–4.806) and SPSS embolization (p = 0.006, HR 0.319, 95% CI 0.140–0.725) as the only predictors of TIPS dysfunction. This monocentric study demonstrates that the position of the cranial stent end is independently associated with the development of TIPS dysfunction. The distance of the cranial stent end to the IVC at the time of TIPS placement should be less than 1 cm in 2D angiography.
Highlights
Liver cirrhosis is a major health care burden
In the modern era of PTFE-covered transjugular intrahepatic portosystemic shunt (TIPS) stents, some studies suggested that characteristics of TIPS stent geometry, such as portal venous inflow, retrieved by two-dimensional (2D) angiography during the procedure might predict TIPS d ysfunction[20,21]
The most frequent indication for TIPS was refractory ascites in one hundred and ninety-one cases (63%); one hundred and twelve (37%) TIPS were implanted for variceal bleeding
Summary
A variety of severe complications of portal hypertension such as variceal bleeding and refractory ascites, lead to high hospitalization rates and increased morbidity and mortality[1]. These severe complications of portal hypertension can be treated by implantation of a transjugular intrahepatic portosystemic shunt (TIPS), which partially redirects the portal venous blood flow to the inferior vena cava (IVC) and thereby reduces the portosystemic pressure g radient[2]. In the modern era of PTFE-covered TIPS stents, some studies suggested that characteristics of TIPS stent geometry, such as portal venous inflow, retrieved by two-dimensional (2D) angiography during the procedure might predict TIPS d ysfunction[20,21]. The aim of this study was to determine whether the 2D TIPS geometrical characteristics at the time of TIPS creation can predict TIPS dysfunction in a large cohort
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