Risk factors for stent graft thrombosis after transjugular intrahepatic portosystemic shunt creation

Abstract

Older age, lower BMI and higher post-TIPS portosystemic gradients were associated with higher hazards of shunt thrombosis after TIPS creation using stent grafts. Higher rates of shunt thrombosis were seen in patients for whom TIPS creation was clinically unsuccessful. The association between TIPS thrombosis and higher post-TIPS portosystemic gradients may indicate impaired flow through the shunt, a finding which may be technical or anatomic in nature and should be assessed before procedure completion.

Quantitative analysis of in-TIPS thrombosis in abdominal CT

“…Over recent years, TIPS has gained increased acceptance in the prevention and treatment of portal hypertension and its complications [19] . Despite scientific progress and advancement in stent technology, in-TIPS thrombosis causing stent occlusion is still one of the leading complications that can lead to TIPS dysfunction [20] , [21] . Since diagnostic performance of Doppler-ultrasonography has been described as poor in literature [22] , [23] , contrast-enhanced CT is an important alternative in the diagnostic of in-TIPS thrombosis and TIPS dysfunction [14] , [24] .…”

North American Practice-Based Recommendations for Transjugular Intrahepatic Portosystemic Shunts in Portal Hypertension

“…[17][18][19][20][21][22] The MELD score performs better in patients with TIPS for variceal bleeding compared with patients with refractory ascites (RA). [23][24][25] Studies have examined additional risk factors for poor outcomes with mixed results, including older age and specific numeric MELD score cut-off values. [24][25][26][27][28][29][30] Variability in patient population and study design limit the ability to determine firm cut-off values.…”

“…[23][24][25] Studies have examined additional risk factors for poor outcomes with mixed results, including older age and specific numeric MELD score cut-off values. [24][25][26][27][28][29][30] Variability in patient population and study design limit the ability to determine firm cut-off values. 4,[31][32][33][34] Determination of TIPS candidacy using the MELD score should take into consideration the relative risk and benefit of TIPS creation, considering the TIPS indication, patient comorbidities, and alternative treatment options.…”

“…Notably, TIPS stenosis can be a precursor to TIPS occlusion or thrombosis. 24 From a procedural standpoint, intervening upon TIPS stenosis is technically simpler than intervening upon TIPS thrombosis. Detecting TIPS stenosis with noninvasive ultrasound and performing TIPS angioplasty may be beneficial if the patient would otherwise progress to TIPS thrombosis before developing clinical symptoms from the recurrent portal hypertension.…”

Evaluation of impact of elective invasive examinations in patients with transjugular intrahepatic portosystemic shunt in the long-term follow up

“…Follow up and TIPS surveillance management differs immensely. TIPS patency rates range between approximately 94 % and 78 % within the first three years after TIPS insertion [7][8][9]. The use of polytetrafluoroethylene-covered stents (PTFE-covered stents) instead of baremetal-stents (BM-stents) has improved both patency rates as well as overall survival [10][11][12][13][14].…”