Stent Dysfunction After Transjugular Intrahepatic Portosystemic Shunt: A 14-Year Experience from a Single Tertiary Medical Center

Abstract

Background: The predisposing factors leading to transjugular intrahepatic portosystemic shunt (TIPS) dysfunction, other than the use of bare stents, which are often the only available options, have not been elucidated well to date. Objectives: To analyze clinical outcomes after TIPS created with bare stents and to assess risk factors for stent dysfunction. Patients and Methods: A total of 102 patients undergoing TIPS between January 1999 and December 2012 were retrospectively assessed. The incidence of stent dysfunction was evaluated, and associated risk factors were analyzed. Results: Symptom recurrence was observed in 51 (50%) patients, and TIPS revision was required in 37 (36%) during the mean follow-up period of 1889 days. The median stent patency and survival times were 470 and 1783 days, respectively. The only independent risk factor for stent dysfunction was portal trunk (right, left, or main portal trunk) access (P = 0.006). The median stent patency with segmental branch access (538 days) was significantly longer than that with portal trunk access (245 days) (P = 0.007). There were no significant differences in patient survival (P = 0.648), worsening of encephalopathy (P = .0742), or major complications (P = 1.000). Conclusion: TIPS created with segmental portal venous access has superior patency over that of TIPS with portal trunk access. However, we found no significant difference in patient survival, worsening of encephalopathy, or major complications between segmental access and portal trunk access.