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Expandable Constrained Transjugular Intrahepatic Portosystemic Shunt: An Individualised Approach for High-Risk

Hannah Rieland1, Timo C Meine2,3, Anja Tiede1

  • 1Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany.

Liver International : Official Journal of the International Association for the Study of the Liver
|December 20, 2025
PubMed
Summary
This summary is machine-generated.

Constrained transjugular intrahepatic portosystemic shunt (cTIPS) is a safe option for high-risk patients, effectively managing portal hypertension symptoms. However, cTIPS is associated with increased risks of shunt dysfunction and revisions compared to standard TIPS.

Keywords:
TIPScardiac decompensationcontraindicationhepatic encephalopathyportal hypertensiontransjugular intrahepatic portosystemic shunt

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Area of Science:

  • Interventional Radiology
  • Hepatology
  • Vascular Surgery

Background:

  • Transjugular intrahepatic portosystemic shunt (TIPS) is effective for portal hypertension but has contraindications.
  • High-risk patients often cannot undergo standard TIPS procedures.
  • Constrained TIPS (cTIPS) offers a modified approach with a reduced diameter.

Purpose of the Study:

  • To investigate the safety and efficacy of cTIPS in high-risk patients.
  • To compare cTIPS outcomes with standard TIPS (sTIPS) in a matched cohort.
  • To evaluate the impact of cTIPS on portal hypertensive symptoms and hepatic encephalopathy.

Main Methods:

  • Elective cTIPS procedures were performed on 60 high-risk patients.
  • A 6 mm stent(-graft) was used to constrain the TIPS endoprosthesis.
  • A propensity score-matched control group of 40 patients with sTIPS was established.
  • Procedural success, complications, and 12-month follow-up data were collected.

Main Results:

  • cTIPS was technically successful in all patients.
  • Both cTIPS and sTIPS reduced the portosystemic gradient (PSG), with a higher post-TIPS PSG in the cTIPS group.
  • TIPS dysfunction and revision rates were significantly higher in the cTIPS cohort.
  • Control of portal hypertensive symptoms was similar, but overt hepatic encephalopathy was less frequent after cTIPS.

Conclusions:

  • cTIPS provides a feasible and safe step-up approach for selected high-risk patients.
  • The procedure requires careful consideration due to an increased risk of thrombosis and revisions.
  • Larger studies are needed to validate these promising findings for cTIPS in managing portal hypertension.