Transjugular Intrahepatic Portosystemic Shunt: Devices Evolution, Technical Tips and Future Perspectives.

Area of Science:

• Hepatology and Interventional Radiology
• Gastroenterology
• Vascular Surgery

Background:

• Portal hypertension (PH) is a critical complication of cirrhosis, leading to severe morbidity and mortality.
• Transjugular intrahepatic portosystemic shunt (TIPS) is a key intervention for managing PH-related complications.
• Stent technology has evolved, significantly impacting TIPS efficacy.

Purpose of the Study:

• To review the evolution of TIPS procedures.
• To highlight the impact of stent advancements on TIPS effectiveness.
• To discuss future directions in TIPS management for PH.

Main Methods:

• Review of historical and current stent technologies used in TIPS.
• Analysis of comparative studies on bare metal stents (BMSs) versus expanded polytetrafluoroethylene-covered stent grafts (ePTFE-SGs).
• Evaluation of technical considerations including stent placement, length, and caliber.

Main Results:

• Early bare metal stents (BMSs) had limited patency due to frequent dysfunction.
• Expanded polytetrafluoroethylene-covered stent grafts (ePTFE-SGs) demonstrated significantly improved patency rates.
• Controlled expansion ePTFE-SGs allow precise diameter adjustment, leading to better outcomes than BMSs, including fewer complications and higher survival rates.
• Optimal stent placement, length, and caliber are crucial for reducing shunt-related complications.

Conclusions:

• Advancements in stent graft technology, particularly ePTFE-SGs, have revolutionized TIPS for portal hypertension management.
• Technical improvements alone are insufficient; integrating hemodynamic, cardiac, and systemic factors is essential for personalized patient care.
• Future progress in stent graft technology and clinical factor management promises to further optimize outcomes for cirrhotic patients with PH.