Elective Transjugular Intrahepatic Portosystemic Shunt Using Viatorr Stent-Grafts: A Single-Center Experience from China

Abstract

Background and Aims: Transjugular intrahepatic portosystemic shunt (TIPS) is a well-established approach for the management of variceal bleeding, refractory ascites, hepatic hydrothorax, and preoperative treatment of portal hypertension prior to major abdominal surgery in patients with compensated cirrhosis, and so on. This study aimed to investigate the safety and long-term efficacy of TIPS implantation using Viatorr TIPS stent-grafts. Material and Methods: A cohort of 59 patients undergoing TIPS placement using Viatorr TIPS stent-grafts were included, and the periprocedural events, and long-term mortality, shunt dysfunction, variceal rebleeding and incidence of hepatic encephalopathy (HE) were analyzed. Results: The technical success rate was 100%. The median portosystemic pressure gradient was reduced from 21 mmHg (interquatile range: 19–25) to 13 mmHg (interquatile range: 10–16) before and after TIPS, leading to a hemodynamic success rate of 72.9%. The cumulative rate of overall mortality was 34.2% at five years, and direct bilirubin (hazard ratio [HR] = 1.336, 95% confidence interval [CI]: 1.050–1.700, P = 0.018) and post-TIPS right atrial pressure (HR = 1.238, 95% CI: 1.015–1.510, P = 0.035) were independent predictors for mortality. The cumulative rates of shunt dysfunction and variceal rebleeding were 11.0% and 28.3% at five years, respectively, and portal venous pressure gradient (HR = 2.572, 95% CI: 1.094–6.047, P = 0.030) was the only independent predictor for shunt dysfunction. The cumulative four-year HE-free rate was 48.6%. No severe adverse event was noted during TIPS procedures. Conclusion: Elective TIPS implantation using Viatorr TIPS stent-grafts is generally safe, and the long-term efficacy is favorable for the treatment of cirrhotic patients with recurrent variceal bleeding or refractory ascites.

TIPS Creation with Viatorr Stent-grafts for Variceal Hemorrhage: a Cohort Study in China

“…Zhou et al found a cumulative survival rate of 91.9% at 1 year following stent-graft insertion (20). LI et al reported the cumulative mortality at 2 years was 12.3% (19). Our results are consistent with these studies, which validates the e cacy of TIPS with Viatorr stents in reducing mortality for these patients.…”

“…Shunt dysfunctions continue to be a signi cant concern regarding TIPS insertion over the long term. Four studies from Chinese and western countries using Viatorr stents have found 2-year risks of 6.9-23.7%, which was similar to our study (19)(20)(21)(22). Zhou et al reported the highest 2-year risk of 23.7%.…”

“…Therefore, the Viatorr stent is regarded as the primary option for creating TIPS, but limited information is available regarding the e ciency and safety of TIPS insertion using Viatorr stents in patients with variceal hemorrhage in China. To our knowledge, only a limited number of small-scale studies have provided preliminary reports on the clinical outcomes of using Viatorr stents for portal hypertension-related complications (19)(20)(21). Additionally, these cases also included other TIPS indications such as refractory ascites.…”

“…Twenty-one patients in our series suffered variceal rebleeding, and the cumulative rebleeding rates in our study at 1, 2, 3 and 4 years were 9.1%, 14.1%, 17.9%% and 25%. In a study conducted by LI et al, where emergency TIPS procedures were not included, the cumulative rates of rebleeding at 1, 2, 3, and 4 years were reported as 3.4%, 8.9%, 17.3%, and 20.3% respectively (19). Zhou et al used Viatorr stents in 42 patients with Variceal bleeding found a 1-year risk of rebleeding of 0% and 2-year risk of 9% (20).…”

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

“…The 1-, 4- and 10-year survival rates were 69.2%, 52.1% and 30.7%, respectively. In a retrospective single-center study by Li et al [ 28 ] including 59 cirrhotic patients with CSPH, elective TIPS implantation using VTS stent grafts contributed to a decrease in PSPG from 21 mmHg (interquartile range: 19-25) to 13 mmHg (interquartile range: 10-16). The cumulative rate of overall mortality was 34.2% at five years.…”