Background Compare the clinical outcome of structure and function between insertion of transjugular intrahepatic portosystemic shunt (TIPS) created with the Viabahn ePTFE covered stent/bare metal stent (BMS) combination and Fluency ePTFE covered stent/BMS combination. Methods 101 consecutive patients undergone TIPS procedure from February 2016 to August 2018 in our center were analyzed retrospectively, 64 subjects were enrolled in Viabahn group and 37 were Fluency group. We caculated the TIPS geometry characteristics and evaluated the related occurrence of shunt dysfunction, survival, overt hepatic encephalopathy (OHE) and variceal rebleeding. Results The technical success rate was 100%. After TIPS insertion, the rate of shunt dysfunction during the first 3 months was significantly different between Viabahn group and Fluency group, which were respectively 1.6% and 13.5% (p = 0.024). And multivariate analysis indicated that the angle of portalvenous inflow (α) (HR = 1.060, 95%CI = 1.009–1.112, p = 0.020) was the only predictor of shunt dysfunction. Besides, after 3 months following TIPS insertion, the α angle distinctly increased from 20.9°±14.3° to 26.9°±20.1° (p = 0.005) in Fluency group but stayed unchanged in Viabahn group (from 21.9°±15.1° to 22.9°±17.6°, p = 0.798). Conclusions The occurence of shunt dysfunction was related to the angle of portalvenous inflow (α), because of the slighter effect on α angle, after TIPS inplanation, Viabahn ePTFE covered stent/BMS combination was more stable in structure and promised higher short-term stent patency compared to Fluency ePTFE covered stent/BMS combination.

Background This study aimed to evaluate the efficacy and safety of a therapeutic strategy, balloon tamponade (BT) sequentially combined with transjugular intrahepatic portosystemic shunt (TIPS), in cirrhotic patients with refractory acute variceal bleeding (AVB), and to introduce technique points of performing TIPS under BT. Methods Fifteen consecutive patients with refractory AVB who had been treated with balloon tamponade sequentially combined with TIPS between February 2017 and November 2019 were retrospectively analyzed. We evaluated the technical success rate, efficacy and procedure-related complications, and compared pre- and post-TIPS portal pressure gradient (PPG). Variceal rebleeding, overt hepatic encephalopathy (OHE), TIPS patency was assessed periodically and survival at 6 weeks and 1 year were recorded during follow-up. Results The procedure was successfully performed in all patients. Balloon was deflated during TIPS procedure in seven patients, after TIPS in three and before TIPS in five. Mean PPG decreased from 27.7 ± 4.3 mmHg to 10.7 ± 2.8 mmHg (P < 0.001). No TIPS- and balloon-related complications were observed. Two patients died during a median follow-up of 12 months (range 1–34 months). The 6-week and 1-year survival rate was 100% and 76% respectively. The incidence of OHE was 21% (3/14). The probability of remaining free of recurrent bleeding was 100%, and the probability of maintaining TIPS patency was 100%. Conclusions Balloon tamponade sequentially combined with TIPS should be considered an effective and safe strategy for patients with refractory AVB (especially bleeding from esophageal varices). This strategy could increase bleeding control rate and reduce the incidence of procedure-related complications and rebleeding.