Stenosis of transjugular intrahepatic portosystemic shunts: presentation and management.

Sterling, Keith M.; Darcy, Michael

doi:10.2214/ajr.168.1.8976952

Cited by 69 publications

(28 citation statements)

References 1 publication

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“…In this study, we carefully assessed TIPS stent dysfunction through hemodynamic measurements and strict long-term clinical follow-up. Our results are in accordance with other studies in terms of stent patency rate and location of stenosis (8)(9)(10)(11)(12)(13)(14)27). Notably, we first revealed that portal trunk access (P = 0.006; OR 2.56; 95% CI, 1.3 -5.04) was the only independent risk factor of TIPS dysfunction in multivariate analysis.…”

Section: Discussionsupporting

confidence: 91%

“…TIPS dysfunction is related to three common causes: acute thrombosis, pseudointimal hyperplasia in the intraparenchymal segment of the stent, and intimal hyperplasia of the hepatic vein outflow tract (16)(17)(18). The incidence of stent dysfunction in patients with TIPS created with bare metal stents is approximately 25% after 6 months or 50% after 1 year (8)(9)(10)(11)(12)(13)(14). To maintain TIPS patency, it is prudent to regularly monitor the shunt with Doppler ultrasound and eventually direct portography with frequent secondary intervention.…”

Section: Discussionmentioning

confidence: 99%

“…However, one of the main issues is the relatively high rate of stent dysfunction (25 -50% of cases at 6 -12 months after TIPS creation with bare stents), leading to recurrence of portal hypertension related complications (8)(9)(10)(11)(12)(13)(14). This high rate of shunt dysfunction made close monitoring of stent patency and frequent costly revisions mandatory, thus rendering TIPS creation a multistage procedure in most cases in which bare stents were used (15).…”

Section: Introductionmentioning

confidence: 99%

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Stent Dysfunction After Transjugular Intrahepatic Portosystemic Shunt: A 14-Year Experience from a Single Tertiary Medical Center

Kim

Gwon

et al. 2017

Iran J Radiol

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Background: The predisposing factors leading to transjugular intrahepatic portosystemic shunt (TIPS) dysfunction, other than the use of bare stents, which are often the only available options, have not been elucidated well to date. Objectives: To analyze clinical outcomes after TIPS created with bare stents and to assess risk factors for stent dysfunction. Patients and Methods: A total of 102 patients undergoing TIPS between January 1999 and December 2012 were retrospectively assessed. The incidence of stent dysfunction was evaluated, and associated risk factors were analyzed. Results: Symptom recurrence was observed in 51 (50%) patients, and TIPS revision was required in 37 (36%) during the mean followup period of 1889 days. The median stent patency and survival times were 470 and 1783 days, respectively. The only independent risk factor for stent dysfunction was portal trunk (right, left, or main portal trunk) access (P = 0.006). The median stent patency with segmental branch access (538 days) was significantly longer than that with portal trunk access (245 days) (P = 0.007). There were no significant differences in patient survival (P = 0.648), worsening of encephalopathy (P = .0742), or major complications (P = 1.000). Conclusion: TIPS created with segmental portal venous access has superior patency over that of TIPS with portal trunk access. However, we found no significant difference in patient survival, worsening of encephalopathy, or major complications between segmental access and portal trunk access.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Stent Dysfunction After Transjugular Intrahepatic Portosystemic Shunt: A 14-Year Experience from a Single Tertiary Medical Center

Kim

Gwon

et al. 2017

Iran J Radiol

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“…Shunt dysfunction is a common problem after TIPS placement, arising in up to 50% of patients when bare metal stents are used (6,7). It is less frequent if a covered stent graft is used, but may still occur in up to 13%-20% of patients.…”

Section: Discussionmentioning

confidence: 99%

Recanalization of occlusive transjugular intrahepatic portosystemic shunts inaccessible to the standard trans-venous approach

Miraglia¹,

Maruzzelli²,

Luca³

2012

Diagn Interv Radiol

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“…Nach TIPSSAnlage kann eine Abflußbehinderung durch Stenosen oder Verschlüsse auftreten. Die meisten Stenosen betreffen dabei den lebervenenseitigen Ausfluß-trakt [1,8,12,16,17,23,27]. Sie treten im ersten Jahr nach TIPSS-Anlage relativ häufig auf und erfordern dann eine Reintervention.…”

Section: Materials Und Methodenunclassified

TIPSS-Kontrolle mit Farbduplexsonographie unter Anwendung eines Ultraschallverstärkungsmittels

et al. 1999

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A study was performed to determine the visualization of the transjugular intrahepatic portosystemic stent shunt (TIPSS) and the detection of stenosis by the use of a capillary transversing signal enhancer. In 37 patients 37 colour-coded duplex sonographies were performed before and after intravenous injection of the ultrasound signal enhancer Levovist (Schering, Berlin). The examinations were evaluated using a four-category score. Special attention was paid to the detection of stenoses in the TIPSS. Transjugular portal venograms of the same day were used as gold standard. The use of Levovist provided better colour and flow signals for the portal vein end of the shunt in only 9 of 37 sonograms and for the hepatic vein end of the shunt in 37 of 39 sonograms. Eleven of 13 stenoses requiring reintervention in portal venography could be correctly identified with signal enhancer. Eleven of these 13 stenoses were located in the hepatic vein end of the shunt. Ultrasound signal enhancer can significantly improve the sonomorphological visualization especially of the hepatic vein end of TIPSS in colour-coded duplex sonography. Stenoses which usually occur in the hepatic vein end of the shunt may be better detected.

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Stenosis of transjugular intrahepatic portosystemic shunts: presentation and management.

Cited by 69 publications

References 1 publication

Stent Dysfunction After Transjugular Intrahepatic Portosystemic Shunt: A 14-Year Experience from a Single Tertiary Medical Center

Stent Dysfunction After Transjugular Intrahepatic Portosystemic Shunt: A 14-Year Experience from a Single Tertiary Medical Center

Recanalization of occlusive transjugular intrahepatic portosystemic shunts inaccessible to the standard trans-venous approach

TIPSS-Kontrolle mit Farbduplexsonographie unter Anwendung eines Ultraschallverstärkungsmittels

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