Three-Dimensional Transjugular Intrahepatic Portosystemic Shunt Geometry Predicts Shunt Dysfunction

Patients with decompensated cirrhosis are at risk of portal hypertension-related complications, such as refractory ascites or variceal bleeding. Transjugular intrahepatic portosystemic shunt (TIPS) insertion is the most effective treatment to reduce portal hypertension. However, patients are at risk for TIPS dysfunction.

We aimed to investigate the prognostic value of three-dimensional (3D) TIPS geometry in predicting TIPS dysfunction.

A total of 107 patients who underwent TIPS insertion between 2014 and 2019 and received a computed tomography (CT) scan after TIPS insertion during routine clinical practice were included. We used a semiautomated algorithm and multiplanar reconstructions of these CT scans to calculate parameters of 3D TIPS geometry. The primary outcome of this study was the development of TIPS dysfunction (defined as need for invasive TIPS revision). To identify predictors for the development of TIPS dysfunction, Cox regression analyses were performed with TIPS dysfunction as the endpoint.

Thirty-two patients developed TIPS dysfunction and were compared to the dysfunction-free 75 patients. A larger distance from the cranial TIPS stent end to the vena cava inferior (p < 0.001, HR 1.061, 95% CI 1.030-1.093) and the maximum stent curvature (p = 0.003, HR 1.020, 95% CI 1.007-1.034) were significantly associated with TIPS dysfunction in a multivariate Cox regression analysis.

A more pronounced stent curvature and a longer cranial stent distance from the inferior vena cava were identified as independent predictors of TIPS dysfunction. Interventionalists should choose a more central and less curved TIPS tract during the TIPS procedure to reduce the risk of development of TIPS dysfunction.

This retrospective monocentric study includes patients from the NEPTUN cohort (registered at ClinicalTrials.gov; Identifier: NCT03628807).