Cranial extension of transjugular intrahepatic portosystemic shunts using dedicated venous stents

Transjugular intrahepatic portosystemic shunt (TIPS) dysfunction commonly occurs due to outflow obstruction at the hepatic venous end of the stent due to inadequate cranial stent coverage. Cranial extension of the shunt utilizing the same type of covered stent as is used for TIPS creation, such as TIPS Endoprosthesis (Gore), is a common practice for revision. This series describes four patients who underwent cranial TIPS extension using dedicated venous stents. Venovo (n = 3; Becton Dickinson) and Abre (n = 1; Medtronic) stents were deployed to extend shunts toward the inferior vena cava. Mean cranial extension was 11.25 ± 2.2 mm, with a mean portosystemic gradient reduction of 8.5 ± 2.1 mmHg and no complications. Dedicated venous stent deployment for cranial TIPS extension is a feasible and cost-effective method to optimize hepatic venous outflow.