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

Area of Science:

• Interventional Radiology
• Hepatology
• Vascular Surgery

Background:

• Portal hypertension complications necessitate Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedures.
• TIPS dysfunction presents a significant clinical challenge, impacting treatment efficacy.

Purpose of the Study:

• To evaluate the prognostic value of two-dimensional (2D) TIPS geometry in predicting TIPS dysfunction.
• To identify specific geometric factors associated with the development of TIPS dysfunction.

Main Methods:

• Retrospective analysis of 307 patients who underwent TIPS between 2014 and 2019.
• Review of 2D angiograms to assess geometric characteristics, including stent position and angles.
• Comparison of geometric parameters between patients with and without TIPS dysfunction.

Main Results:

• Cranial stent end position within the hepatic vein and persistent spontaneous portosystemic shunts were linked to TIPS dysfunction.
• Multivariable analysis identified cranial stent position (HR 2.300) and SPSS embolization (HR 0.319) as independent predictors.
• A cranial stent end-to-IVC distance < 1 cm on 2D angiography was associated with reduced dysfunction risk.

Conclusions:

• The position of the cranial stent end is an independent predictor of TIPS dysfunction.
• Optimizing cranial stent placement, specifically maintaining a distance < 1 cm to the IVC, may mitigate TIPS dysfunction risk.