TIPS in patients with portal hypertension – patency depends on coverage

Background:

TIPS is the treatment of choice in decompensated portal hypertension (PH). TIPS revision due to thrombosis or stenosis increases morbidity and mortality.

Patients and Methods:

We retrospectively evaluated 189 patients who underwent TIPS procedure. Only patients who required TIPS revision within one year (group I, 34 patients) and patients who did not require re-intervention within the first year (group II (control group), 54 patients) were included.

Results:

Out of 88 patients, the majority was male (69.3%) and mean age was 56 ± 11 years. Indications for TIPS were refractory ascites (68%), bleeding (24%) and Budd-Chiari syndrome (8%). Most frequent liver disease was alcohol-induced cirrhosis (60%). Forty-three patients (49%) received bare and 45 patients (51%) covered stents, thus resulting in reduction of HVPG from 19.0 to 9.0 mmHg. When comparing patient- and procedure-related factors, type of stent was the only independent factor affecting risk of re-intervention due to stent dysfunction (p < 0.01), while age, gender, indication, Child-Pugh score, MELD score, platelet count, pre and post HVPG, additional variceal embolization, stent diameter, and number of stents did not significantly differ.

Conclusions:

Patients undergoing TIPS procedure should be surveilled closely for shunt dysfunction while covered stents are associated with increased patency.