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Computed Tomography (CT) Guided Implantation of a Totally Implantable Venous Access Port (TIVAP) through Subclavian Vein
Published on: January 13, 2026
[Repeat endovascular interventions after transjugular intrahepatic portosystemic shunt (tips) procedures]
Summary
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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