Cranial stent position is independently associated with the development of TIPS dysfunction

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.

Decreased Platelet Aggregation in Patients with Decompensated Liver Cirrhosis and TIPS Implantation

“…The most likely reason was an unfavorable placement of the TIPS device, as depicted in Figure S1. Such an explanation has also been proposed by others [8,42].…”

“…The use of covered stents has markedly reduced stent stenosis and thrombosis. Nowadays, TIPS dysfunction is mainly due to technical aspects (e.g., damage of the covering of the stent) or caused by hemodynamical changes within the stent (insufficient position in the liver vein [ 8 ]), leading to a non-laminar flow and, subsequently, to the development of stenosis or thrombosis. However, in comparison to patients with coronary artery disease and stent implantation, an intervention in which platelets play a crucial role in the pathogenesis of stent thrombosis, the role of platelets in TIPS dysfunction is unknown.…”

Milestones to optimize of transjugular intrahepatic portosystemic shunt technique as a method for the treatment of portal hypertension complications

“…An important condition for PTFE-SGs installation is to ensure their sufficient length: so that they are located in the right or left branch of the portal vein at a distance of at least 1-2 cm from its bifurcation (uncovered part), passes through the channel formed in the liver parenchyma and then along the hepatic vein to the confluence with the inferior vena cava (covered part). At the same time, the distance of the cranial stent end to the inferior vena cava should be no more than 1 cm[ 23 ]. It is also necessary to completely cover the intraparenchymal channel to prevent bile from entering the stent lumen and the development of pseudo-intimal hyperplasia[ 24 ].…”