Stent fracture after transjugular intrahepatic portosystemic shunt: A case report

Transjugular intrahepatic portosystemic shunt (TIPS) is a highly effective treatment for complications associated with portal hypertension. However, stent fracture, although extremely rare, represents a potentially serious complication following TIPS creation. Timely identification and management are crucial for preventing further adverse events.

We report a 56-year-old male patient who underwent a TIPS procedure for recurrent melena caused by portal hypertension secondary to hepatitis B and experienced a stent fracture 15 months post-procedure. He was readmitted 30 months after the initial TIPS due to recurrent esophagogastric variceal bleeding and ascites. An attempt to revise the dysfunctional shunt via a stent-in-stent approach was unsuccessful. Consequently, a parallel TIPS procedure was successfully performed via the proximal end of the fractured stent to decompress the portal venous system. At the 1-month follow-up, the patient exhibited no recurrent variceal bleeding, and his ascites had significantly decreased. Twelve-month postoperative monitoring revealed no hepatic encephalopathy and no recurrence of bleeding or ascites. Additionally, we review the existing literature on post-TIPS stent fractures to explore the underlying mechanisms contributing to this complication.

Early recognition and prompt intervention are essential in managing stent fractures after TIPS creation to mitigate potential risks and ensure optimal patient outcomes.