Transjugular Intrahepatic Portosystemic Shunt Through the Strut of a Previously Placed Stent: Technical Feasibility and Long-Term Follow-Up Results.

Abstract

To evaluate technical feasibility, long-term primary patency and clinical outcome of the transjugular intrahepatic portosystemic shunt (TIPS) through the struts of the previously placed stents. Retrospective evaluation of seven consecutive patients (three male and four female, age range 13-65years, median 28) out of a total 95 patients, who underwent TIPS through the strut of the previously placed stents of hepatic vein (HV), inferior vena cava (IVC) or TIPS in a single tertiary care hospital. Six of the patients were diagnosed with Budd-Chiari syndrome(BCS) and one with alcohol-induced chronic liver disease(CLD). Kaplan-Meier test was used to calculate 18- and 60-month primary patency rate of TIPS stent. TIPS through the strut of a previously placed stent was technically successful in all the patients (100%). The TIPS was direct intrahepatic portosystemic shunt (DIPS) in 5/7 cases, due to occluded HV. Mean portosystemic pressure gradient (PPG) reduced from 24mmHg ± 5.9 (range, pre-TIPS 15-31mmHg) to 8.57mmHg ± 4.4 (range, post-TIPS, 3-14mmHg). One patient required three sessions of TIPS revisions. Another patient needed TIPS revision after 5years of TIPS creation. All the patients showed improvement in clinical symptoms and in mean Child-Turcotte-Pugh (CTP) score and modified end-stage liver disease (MELD) score during mean follow-up period 40.57month ± 34.9 (range 3-100month). Primary patency rates of TIPS stent measured with Kaplan-Meier estimate at 18- and 60-month follow-up were 80% (95% CI, 37-97%) and 40% (95% CI, 10-97%), respectively. TIPS through the strut of a previously placed stent is technically feasible with good long-term primary patency and clinical outcome.