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[Repeat endovascular interventions after transjugular intrahepatic portosystemic shunt (tips) procedures]

V N Shipovskiĭ, M Sh Tsitsiashvili, A M Saakian

    Angiologiia I Sosudistaia Khirurgiia = Angiology and Vascular Surgery
    |November 2, 2010
    PubMed

    Insights

    Transjugular intrahepatic portosystemic shunt (TIPS) procedures can lead to in-stent thrombosis, particularly with matrix and self-expanding stents. Endovascular recanalization effectively restores stent patency and reduces variceal bleeding.

    Area of Science:

    • Interventional Radiology
    • Hepatology
    • Vascular Surgery

    Background:

    • Transjugular intrahepatic portosystemic shunt (TIPS) is a critical intervention for managing complications of advanced liver disease, such as portal hypertension, ascites, and esophageal varices.
    • Hepatocirrhosis, classified by Child-Turcotte-Pugh (CTP) stages B and C, presents significant management challenges due to portal hypertension and its sequelae.
    • Maintaining shunt patency is crucial for the long-term efficacy of TIPS in preventing variceal hemorrhage and managing ascites.

    Purpose of the Study:

    • To evaluate the incidence and management of in-stent thrombosis following TIPS procedures.
    • To compare the rates of thrombosis among different stent types used in TIPS.
    • To assess the effectiveness of endovascular techniques in restoring stent patency and preventing recurrent variceal bleeding.

    Main Methods:

    • Retrospective analysis of 59 patients undergoing TIPS for CTP class B/C hepatocirrhosis, portal hypertension, or ascites.
    • Categorization of stents into matrix (PERICO), self-expanding (ZA-stents, OptiMedsinus-SuperFlex-Visualstents, Zilverstents, SMART), and coated self-expanding (Gore Viatorr).
    • Diagnosis of in-stent thrombosis via ultrasonographic duplex scanning; assessment of patency rates and outcomes of endovascular interventions.

    Main Results:

    • Six procedures (11%) failed initially. Of 53 successful TIPS, 13 patients (24.5%) developed in-stent thrombosis.
    • Thrombosis rates were higher with matrix stents (23.0%) and self-expanding stents (61.0%) compared to coated stents.
    • Primary stent patency was 67%, with a secondary assisted patency of 89% after interventions like recanalization and angioplasty.

    Conclusions:

    • In-stent thrombosis is a significant complication of TIPS, with varying incidence based on stent type.
    • Endovascular restoration of stent lumen patency is an effective and minimally invasive strategy.
    • Successful interventions significantly decrease the rate of recurrent esophageal variceal hemorrhage, preserving shunt function.

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