Causes of TIPS Dysfunction

Abstract

Biologic and technical factors may predispose to shunt failure. The combination of improved technique and expandable PTFE has significantly improved TIPS patency. The need for follow-up venography and secondary interventions has been reduced significantly as a result of improved shunt patency.

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

“…In this study, we carefully assessed TIPS stent dysfunction through hemodynamic measurements and strict long-term clinical follow-up. Our results are in accordance with other studies in terms of stent patency rate and location of stenosis (8)(9)(10)(11)(12)(13)(14)27). Notably, we first revealed that portal trunk access (P = 0.006; OR 2.56; 95% CI, 1.3 -5.04) was the only independent risk factor of TIPS dysfunction in multivariate analysis.…”

“…TIPS dysfunction is related to three common causes: acute thrombosis, pseudointimal hyperplasia in the intraparenchymal segment of the stent, and intimal hyperplasia of the hepatic vein outflow tract (16)(17)(18). The incidence of stent dysfunction in patients with TIPS created with bare metal stents is approximately 25% after 6 months or 50% after 1 year (8)(9)(10)(11)(12)(13)(14). To maintain TIPS patency, it is prudent to regularly monitor the shunt with Doppler ultrasound and eventually direct portography with frequent secondary intervention.…”

“…Other investigators reported that failure of the caudal end of the stent to be parallel to the vascular wall of the portal vein probably induces portal vein stenosis (13,41). In this study, we carefully assessed TIPS stent dysfunction through hemodynamic measurements and strict long-term clinical follow-up.…”

“…However, one of the main issues is the relatively high rate of stent dysfunction (25 -50% of cases at 6 -12 months after TIPS creation with bare stents), leading to recurrence of portal hypertension related complications (8)(9)(10)(11)(12)(13)(14). This high rate of shunt dysfunction made close monitoring of stent patency and frequent costly revisions mandatory, thus rendering TIPS creation a multistage procedure in most cases in which bare stents were used (15).…”

Sonographic evaluation of transjugular intrahepatic porto-systemic shunt

“…Bare metal stent stenosis is described as pseudointimal hyperplasia as a result of fistulas between the shunt and bile ducts. Second, stenosis can occur at the hepatic vein due to intimal hyperplasia caused by chronic injury from increased highvelocity blood flow (16). Given the fact that TIPS malfunction is relatively frequent with bare metal stents and because of the success of shunt revision, it is crucial to detect stenosis before recurrence of clinical symptoms.…”