Transjugular intrahepatic portosystemic shunt with ePTFE-covered stentgrafts: incidence and predictors of shunt dysfunction

作者：Michael B. Pitton, Lukáš Müller, Fabian Stoehr, Arndt Weinmann, Christian Labenz, Jens Mittler, Roman Kloeckner, Christoph Düber, Gerd Otto · 发表于：Insights into Imaging · 年份：2025 · DOI：10.1186/s13244-025-02122-2 · 被引用次数：3 · 研究领域：Liver Disease and Transplantation、Organ Transplantation Techniques and Outcomes、Congenital Heart Disease Studies

OBJECTIVES: To analyze revision rates after transjugular intrahepatic portosystemic shunt (TIPS) using expanded polytetrafluoroethylene-covered stentgrafts and to identify predictors of shunt revisions. MATERIALS AND METHODS: This single-center retrospective study included 514 consecutive patients (mean age 56.9 ± 12.7 years; 194 females) with TIPS placement between 2003 and 2021. Follow-up included clinical assessment, laboratory testing, ultrasound, and computed tomography. Reinterventions were categorized by type and technique. Univariable and multivariable Cox regression analyses were performed to identify predictors of shunt dilation and reduction. RESULTS: A total of 149 patients (28.9%) required TIPS revision: 95 (18.5%) shunt dilation, 42 (8.2%) shunt reduction, and 12 (2.3%) others. Median time to first revision was 2.8 months (3.2 months for dilation, 1.9 months for reduction). Indications for first shunt dilation were persistent or recurrent refractory ascites (n = 61), recurrent variceal bleeding (n = 7), and asymptomatic stenosis or occlusion of the TIPS tract (n = 27). Indications for shunt reduction were hepatic encephalopathy refractory to conservative measures (n = 39) and acute liver failure following TIPS (n = 3). Forty-seven patients (9.1%) underwent two or more reinterventions. Multivariable Cox analysis identified immediate post-TIPS portosystemic pressure gradients > 8 mmHg, prior hepatic encephalopathy, and hepatorenal syndrome prior to TIPS as predict...