Retrospective Single-Center Study on Patency and Clinical Outcomes of Transjugular Intrahepatic Portosystemic Shunt Placement Using Niti-S Stents in Patients with Cirrhosis

Abstract

Purpose

To evaluate the primary patency rates and clinical outcomes of the Niti-S expanded polytetrafluoroethylene-covered stent when used for transjugular intrahepatic portosystemic shunt (TIPS) creation in cirrhotic patients, and to compare outcomes with published Viatorr benchmarks.

Methods

This retrospective single-center study included 96 cirrhotic patients who underwent de novo TIPS placement using Niti-S ComVi biliary (end bare-type) stents between April 2021 and March 2024. Indications included variceal bleeding (54%) and recurrent or refractory ascites (46%). TIPS creation followed a standardized protocol, and patients were prospectively followed with Doppler ultrasound and clinical assessment. The primary endpoint was 12-month primary patency, defined as uninterrupted stent function without re-intervention.

Results

Hemodynamic success was 100%, with significant reduction in portal pressure gradient (from 23  ±  5 to 9  ±  4 mmHg). Primary patency rates at 6 months, 1 year, and 2 years were 97, 96, and 92%, respectively. There was no significant difference in patency by TIPS indication. At 1 year, clinical outcomes demonstrated a 96% rate of freedom from rebleeding and complete resolution of ascites in 91% of patients. After a median follow-up of 20 months, 12.5% patients developed hepatic encephalopathy, including 3.2% with episodes of West Haven grade III–IV severity. Comparative analysis revealed that the patency rates and clinical outcomes of the Niti-S stent were on par with those reported for Viatorr.

Conclusion

The Niti-S covered stent demonstrated excellent 1-year patency and clinical efficacy in TIPS creation. It offers a viable alternative in resource-limited settings, with effective portal decompression and low complication rates.

Keywords

variceal bleeding - encephalopathy - ascites

Introduction

Transjugular intrahepatic portosystemic shunt (TIPS) creation has become an established therapy for complications of portal hypertension, such as variceal hemorrhage and refractory ascites.[1] A well-known limitation of the TIPS procedure—particularly during the era of bare metal stents—has been the progressive development of in-stent stenosis or occlusion due to pseudointimal hyperplasia, leading to shunt dysfunction and recurrence of symptoms. Historically, bare metal TIPS stents exhibited primary patency rates of only around 25 to 55% at 1 year.[2] [3] This high rate of shunt failure necessitated frequent surveillance and re-interventions, and contributed to poorer long-term clinical efficacy.

The development of expanded polytetrafluoroethylene (e-PTFE)-covered stent grafts for TIPS represented a major advance in maintaining shunt patency. The Viatorr TIPS endoprosthesis (W. L. Gore and Associates) was specifically designed for TIPS, featuring a PTFE lining to exclude the liver parenchyma from the shunt lumen and an uncovered segment to preserve portal perfusion. Multiple studies demonstrated that e-PTFE-covered stents dramatically improved TIPS patency compared with bare stents, with 1-year primary patency rising into the 80 to 90% range.[3] [4] A landmark randomized controlled trial reported that using covered stents improved 1-year patency to 86% versus 56% with bare stents (p ≤ 0.01), without increasing encephalopathy risk.[4] Subsequent large studies and meta-analyses confirmed Viatorr's excellent long-term patency, establishing it as the reference standard for TIPS.[5] [6]

However, the Viatorr stent is not universally available due to financial constraints and regulatory limitations, which restrict its widespread use. As a result, alternative strategies have emerged, such as using nondedicated generic covered stents (e.g., Fluency plus stent from Becton, Dickinson and Company) often in combination with bare metal stents to mimic the Viatorr design.[7] [8] [9] [10] Additionally, other stent grafts have been explored for TIPS creation.[3] [11] One such device is the Niti-S ComVi biliary (end bare-type) stent (Taewoong Medical, South Korea), a self-expanding partially covered nitinol stent originally engineered for use in malignant biliary strictures to prevent tumor ingrowth.[11] Owing to the unavailability of the Viatorr stent in our region, we have adopted its use at our center.

The Niti-S stent used in our study consists of a biocompatible PTFE membrane sandwiched between two layers of uncovered nitinol wire. The stent's proximal portion is covered with graft material, while the distal end features a 2-cm bare metal segment—designed to prevent jailing of uninvolved ducts in the pancreaticobiliary system—which can be repurposed for deployment within the portal vein ([Fig. 1]). It is available to us in 8 and 10 mm diameters, with a total length of the stent (including the uncovered segment) ranging from 7 to 12 cm. The delivery shaft is of 9F diameter with a relatively short usable length of 90 cm to facilitate percutaneous use. Due to the lack of attachment between the two wire layers and the unfixed cell structure, the ComVi stent exhibits lower axial force compared with other generic e-PTFE-covered stents used in TIPS, such as the Fluency plus stent. This design allows for better conformability to the TIPS tract and reduces the risk of kinking. The outer wire mesh also prevents the risk of migration. Gold radiopaque markers denote the transitions between covered and uncovered segments, aiding precise deployment ([Fig. 2]). This stent design mirrors the Viatorr concept of a covered intrahepatic segment to prevent pseudointimal hyperplasia, while maintaining a bare portion to anchor in the portal vein to allow perfusion of portal venous branch vessels.

Fig. 1 Image of the Niti-S ComVi biliary stent (end bare-type).

Fig. 2 (A, B) TIPS venogram from a patient in the current study cohort demonstrating radio-opaque markers indicating the junction between the graft and bare metal segments of the Niti-S stent (solid arrow), and marking the proximal stent end (dashed arrow), facilitating accurate placement. TIPS, transjugular intrahepatic portosystemic shunt.

Only limited data from Asia exist on the clinical performance of the Niti-S stent for TIPS. A single-center study from Korea reported that an earlier version of the Niti-S partially covered stent achieved a significantly higher 12-month primary patency compared with bare stents in the same series.[3] To date, there have been no direct head-to-head comparisons between Niti-S and Viatorr in a randomized trial. In this context, we conducted a retrospective analysis of our institution's experience of TIPS with the newer generation Niti-S stents, focusing on 1-year patency and clinical outcomes. We then contextualized our findings through comparison with published Viatorr patency rates from the literature. By evaluating whether the real-world performance of the Niti-S stent is comparable to the well-established outcomes of the Viatorr stent, we aim to provide insights for interventionists working in centers where alternative TIPS stents are utilized or required.

Methods

We conducted a retrospective single-center study of all patients who underwent de novo TIPS creation using 10-mm diameter Niti-S ComVi biliary (end bare-type) stents between April 2021 and March 2024 at our institution. Institutional ethics committee approval was obtained for the study. Adult patients with cirrhosis-related portal hypertension who underwent TIPS placement using a Niti-S stent during the study period were included. The primary endpoint was primary patency at 12 months, defined as the proportion of TIPS that remained patent and clinically functional for 1 year without any re-intervention. Exclusion criteria comprised patients without adequate follow-up, those without underlying cirrhosis (e.g., Budd–Chiari syndrome, veno-occlusive disease, and other causes of noncirrhotic portal hypertension), those undergoing TIPS revision or treated with alternative stent types (such as Fluency plus, Covera, Solaris, Hanarostent, Begraft, or Wallgraft) or smaller stent diameter (<10 mm), patients treated for indications other than variceal bleeding and ascites (e.g., hepatic hydrothorax, pre-surgical), and individuals with portal vein thrombosis or malignancy identified on preprocedural imaging. Out of 246 patients who underwent TIPS during the study period at the authors' institute, 96 patients met the inclusion criteria.

Patient demographics, liver disease etiology, Child–Pugh class, and Model for End-Stage Liver Disease with sodium (MELD-Na) score at TIPS were recorded. Key baseline characteristics of the cohort are summarized in [Table 1].

Table 1 Summary of baseline demographic characteristics of the patient cohort

Characteristic	Value
Age, years (mean ± SD)	57 ± 10 (range: 39–75)
Sex, n (%)	63 male (65%); 33 female (35%)
Etiology of portal hypertension	MASLD: 61 (64%); alcohol: 22 (23%); viral: 4 (4%); other: 9 (9%)
Child–Pugh class, n	A: 8 (8%); B: 61 (64%); C: 27 (28%)
MELD-Na score (mean ± SD)	15.2 ± 3.9
TIPS for variceal bleeding, n (%)	52 (54%)
TIPS for ascites, n (%)	44 (46%); recurrent ascites: 18 (41%); refractory ascites: 26 (59%)

Abbreviations: MASLD, metabolic dysfunction–associated steatotic liver disease; MELD, model for end-stage liver disease; SD, standard deviation; TIPS, transjugular intrahepatic portosystemic shunt.

TIPS Creation

All TIPS procedures were performed under general anesthesia, guided by transabdominal ultrasound using a standardized technique,[11] by a single interventional radiologist (R.S.) with 14 years' experience in hepatobiliary interventions. Stents were deployed such that the lower end of the covered portion of stent projected marginally into the portal vein beyond the tract, and the hepatic end extended to the junction of the hepatic vein and inferior vena cava ([Fig. 2]). In 14 cases (14.5%), adjunctive embolization of large gastroesophageal or ectopic varices or large spontaneous portosystemic shunts was performed at the time of TIPS using a combination of coils, plugs, and n-butyl cyanoacrylate glue to prevent potential persistent variceal shunting. After stent placement, the portosystemic pressure gradient (PPG) was measured; additional dilatation (up to 10 mm) was performed if needed to achieve a PPG ≤12 mmHg or a >50% reduction from baseline. All patients received prophylactic antibiotics per protocol. No adjunctive anticoagulation therapy was prescribed to any patient after the TIPS procedure. Procedure-related adverse events were graded as per the Society of Interventional Radiology (SIR) classification.[12]

Follow-Up and Patency Assessment

Patients were followed with a standardized imaging and clinical surveillance protocol. Doppler ultrasound was performed prior to discharge at 1, 3, 6, and 12 months after TIPS creation, then at 6- to 12-month intervals thereafter if no abnormalities were detected. Gray-scale ultrasound indicators of potential TIPS dysfunction included newly detected in-stent echogenic material or absence of flow. Doppler ultrasound criteria for TIPS malfunction comprised a peak systolic velocity within the shunt of less than 90 cm/s or more than 190 cm/s, a change exceeding 50 cm/s from previously recorded peak velocity, and/or hepatofugal flow in the intrahepatic portal vein branch supplying the TIPS.[9] If an ultrasound suggested possible stenosis or occlusion, confirmatory cross-sectional imaging was obtained. Clinical follow-up included assessment for recurrent variceal bleeding, refractory ascites, or new/refractory hepatic encephalopathy (HE) at each visit. In cases with recurrence of portal hypertensive symptoms despite a patent stent on ultrasound, cross-sectional imaging was performed, followed by catheter venography and portosystemic pressure measurements, if indicated.

Definitions

Recurrent and refractory ascites were defined according to the International Club of Ascites guidelines.[13] Refractory variceal bleeding (which includes failure to control bleeding and early rebleeding) and recurrent bleeding were defined according to the European Association for the Study of the Liver guidelines.[14]

TIPS occlusion was defined as complete cessation of flow through the stent on imaging. A significant shunt stenosis was defined as features of lumen narrowing with abnormal hemodynamics (identified on Doppler and confirmed by computed tomography or venography) and recurrence of the portal hypertensive symptom for which TIPS was originally performed. In patients for whom TIPS was done for variceal bleeding, reappearance of varices on endoscopy in patients with abnormal Doppler parameters or shunt narrowing on cross-sectional imaging was considered as indicative of clinically significant shunt stenosis. For patency analysis, an occlusion or significant stenosis requiring intervention was counted as a loss of primary patency at the time of detection. Secondary patency was defined as patency restored after additional stent placement. Patients were censored at the time of liver transplant (if applicable) or at the last imaging follow-up.

Complete resolution of ascites was defined as the absence of ascites on transabdominal ultrasound within 3 months after the TIPS procedure, either without diuretic therapy or with only low-dose diuretics. Partial resolution referred to the persistence of ascites on imaging at 3 months in patients still receiving diuretics. No response was defined as the presence of gross ascites or the continued requirement for paracentesis.

Statistical Analysis

To contextualize the Niti-S patency results, we performed a comparative analysis against published Viatorr outcomes. Through a literature review, we identified representative studies reporting 1-year primary patency for Viatorr stent grafts.[2] [4] [7] [8] [9] [10] We used these published rates for indirect comparison. A chi-square test (for proportions) was used to compare our cohort's 1-year patency to the reported rate from the literature (with continuity correction for small event numbers). This indirect comparison, while exploratory, provides an initial assessment of whether Niti-S patency is within the same range as Viatorr.

Results

Variceal bleeding was the predominant indication, observed in 52 of 96 patients (54%). Among these, 41 patients presented with recurrent variceal hemorrhage (32/41; 78%) or refractory hemorrhage (9/41; 22%), while 11 patients underwent pre-emptive TIPS during an acute variceal bleed (early TIPS within 72 hours in high-risk patients to prevent rebleeding).[14] Of the variceal hemorrhage cases, 43 were due to esophageal varices and 4 were due to ectopic varices (rectal in 1, duodenal in 2, and jejunal in 1). Five patients had both gastric and esophageal varices. The second most common indication was difficult-to-treat ascites, observed in 44 patients (46%), comprising 18 (41%) with recurrent ascites and 26 (59%) with refractory ascites. Among these, four had concomitant hepatorenal syndrome-acute kidney disease and one had hepatorenal syndrome-chronic kidney disease.

The portal pressure gradient decreased significantly following TIPS placement, from a pre-TIPS value of 23  ±  5 to 9  ±  4 mmHg post-TIPS, representing a 61% reduction, with 93% of patients achieving a gradient ≤12 mmHg. No cases of inadequate portal pressure reduction (hemodynamic failure) were observed.

Major adverse events (SIR grade C–D) occurred in 11 patients (11.5%), comprising pulmonary edema (n = 1), sepsis (n = 1), segmental hepatic infarction with right upper quadrant pain (n = 1), significant deterioration of liver function (>2-fold rise in direct bilirubin; n = 3), transient renal impairment (n = 2), and West Haven grade III–IV HE (n = 3). Minor complications (SIR grade A–B) included hepatic arterial puncture (n = 1), bile duct puncture (n = 1), fever (n = 2), and grade I–II encephalopathy (n = 9).

The median follow-up was 20.3 months (interquartile range: 12–30 months). By study censor date (June 1, 2025), 12 patients (12.5%) had undergone liver transplant and were censored at the time of transplant. An additional 14 patients died from progression of liver disease during follow-up (with patent TIPS at time of death), and were censored accordingly. The remaining patients had ongoing follow-up or last imaging confirming status.

The 1-year primary patency rate for Niti-S TIPS was 96% by Kaplan–Meier analysis ([Fig. 3]). At 6 months, primary patency was 97%, and at 2 years it was 92%. Primary patency at the last follow-up (up to 44 months) was 88%. There were no significant differences in patency by TIPS indication (bleeding vs. ascites) in this cohort (p = 0.902).

Fig. 3 Kaplan–Meier curve of the primary patency rate of Niti-S stent.

During follow-up, TIPS dysfunction occurred in eight patients (8.3%). Four failures were observed within the first year, and four additional shunt occlusions at 13, 14, 15, and 24 months. Of these, five were in patients with recurrent variceal bleeding and three in patients with ascites. All eight underwent evaluation for TIPS revision. Four patients underwent successful interventions: two early thromboses (at 1 and 3 months) were treated with thrombectomy and placement of a second covered stent, and two stenoses (at the portal venous end, at 13 and 15 months) were treated with balloon angioplasty and additional stenting. Another patient in whom TIPS was done for recurrent ascites had a stent occlusion within 3 days of the procedure and underwent revision with another covered stent (Hanarostent, M.I. Tech, South Korea). However, he had a re-occlusion after 1 week despite being put on anticoagulation. He declined further interventions and was lost to follow-up. These interventions resulted in a 1-year secondary patency rate of 98.9% and 2-year secondary patency of 97.9%. The remaining three patients with dysfunction did not undergo revision: two had a TIPS occlusion at 9 and 14 months and elected for transplant, and one had an occlusion at 24 months discovered incidentally at transplant workup (both were censored from primary patency at occlusion).

Only 2 of 52 patients (4%) treated for variceal hemorrhage experienced rebleeding during follow-up, both occurring from esophageal varices in the context of shunt occlusion (at 1 and 9 months). Among the 44 ascites patients, 36 (84%) showed complete ascites resolution post-TIPS. Five patients had partial response at 3 months, requiring occasional paracentesis, and 3 had no significant improvement (one of whom had shunt stenosis, which was later corrected, resulting in delayed ascites relief; the other two had concomitant renal dysfunction). Three of the five patients with partial response had complete resolution of ascites by 1 year, resulting in a cumulative 1-year response rate of 91% in the whole cohort.

Discussion

Multiple studies have reported 12-month primary patency rates of 89 to 98% with Viatorr ([Table 2]).[2] [4] [7] [8] [9] [10] [15] In comparison, the 1-year patency rate with Niti-S stents in our cohort was 96%, which was not significantly different from the average reported for Viatorr (92.8%, p = 0.25). Notably, the 95% confidence interval for 1-year patency in our cohort (∼93–100%) overlaps with the published range for Viatorr. By 2 years, our Niti-S primary patency (92%) also appears on par with Viatorr 2-year rates reported in prior studies (85–90%; p = 0.137).[2] [4] [7] [8] [9] [10] [15] Thus, within the constraints of cross-study comparison, Niti-S TIPS demonstrated 1- and 2-year patency rates comparable to Viatorr, although a randomized trial would be needed to confirm any true difference.

Table 2 Summary of previous studies comparing Viatorr with a generic stent graft

Study/cohort	Stent type	n (TIPS)	1-year primary patency (%)	2-year primary patency (%)	Statistical significance
Wang et al[8]	Viatorr	35	95%	86%	p = 0.983
	Fluency	83	92%	88%
Li et al[15]	Viatorr	63	98.4%	96.8%	p = 0.913
	Fluency	41	92.7%	92.7%
	Fluency + E-Luminexx	76	94.7%	93.4%
Bai et al[10]	Viatorr	63	88.5%	–	p = 0.259
	Fluency + E-Luminexx	82	93.4%	–
Wu et al[7]	Viatorr	59	93.1%	93.1%	p < 0.001
	Fluency	154	85.8%	64.6%
Seo et al[3]	Niti-S covered stent	23	86.0%	79.9%	p = 0.009
	Wallstent	20	55.8%	45.8%
Saad et al[9]	Viatorr	93	89%	70%	p = 0.03
	Fluency	28	81%	–
	Viatorr + Fluency	5	–	–	–
	Overall	126	87%	62%	–
Jung et al[2]	Viatorr/Fluency	39/1	38%	–	p = 0.65
	Bare (Wallstent/Smart stent)	39/2	24%	–

Beyond patency outcomes, the Niti-S TIPS cohort demonstrated favorable clinical efficacy, with a mean portal pressure reduction of 14 mmHg and effective control of portal hypertension–related complications in the vast majority of the patients. There were no incidences of rebleeding among patients with sustained primary patency. The 4% rebleeding rate at 1 year in our cohort compares very favorably to historical rebleeding rates of >20% with bare stents, and is on par with results in the Viatorr era where adjunct embolization and covered stents have reduced rebleeding to around 6%.[16] The complete response rate of ascites to TIPS in our study at 1 year was 91%, marginally higher than previously reported rates, likely due to the larger proportion of patients with recurrent ascites in our group who required less frequent paracentesis.[17] [18] No ascites patient experienced recurrence of tense ascites during the follow-up unless associated with shunt dysfunction. New or worsened HE occurred in 12 patients (12.5%) during follow-up. Most were mild (West Haven grade I–II) and managed with lactulose/rifaximin. Three patients (3.2%) developed severe HE (grade 3–4) episodes requiring hospitalization; all responded to medical therapy, and none required TIPS reduction or occlusion. The incidence of post-TIPS HE in our cohort is consistent with published rates for covered stents (10–30%).[8] [12] We did not observe a significant difference in HE rates between Niti-S and literature reports of Viatorr (e.g., 4% major HE in the Viatorr group of one study).[9]

Our findings align with previous studies from Asia evaluating the Niti-S stent. In a Korean cohort of 43 patients, Seo et al reported a 1-year patency rate of 86% with Niti-S stents, compared with 56% with bare stents (p = 0.009).[3] Their study utilized an earlier generation stent design, featuring a covered midsection of 3 to 4 cm with uncovered portions (each measuring 2 cm) at both ends. An Indian study reported a 1-month primary patency rate of 90% for the Niti-S stent in TIPS, in a cohort of 162 patients where the Viatorr stent was also used in 39% of patients.[11] The 1-year primary patency rate for the Niti-S stent was not explicitly stated; however, only four additional stent occlusions occurred between 1 month and 1 year. It remains unclear how many of these occlusions involved Niti-S stents. The comparatively lower patency rates observed in this study relative to our cohort may be attributable to the high proportion (56%) of patients with Budd–Chiari syndrome, a prothrombotic condition associated with increased stent occlusion risk.

An important contextual factor influencing stent choice in India is the lack of availability of the Viatorr stent, which remains the globally established reference device for TIPS creation. In contrast, the Niti-S ComVi stent is readily available in the Indian market at nearly half the cost of Viatorr. This difference has significant financial implications in a country where the majority of patients bear treatment expenses out-of-pocket. The reduced device cost, coupled with the comparable patency and clinical efficacy demonstrated in our cohort, translates into substantial cost savings without compromising clinical outcomes. These economic advantages are particularly relevant in resource-limited health care systems, and support the role of Niti-S as a pragmatic alternative to Viatorr for TIPS creation in India.

This study is limited by its retrospective design and the lack of a direct concurrent control group with Viatorr stents. The comparison to Viatorr is based on published historical data, which, while contextual, do not substitute for a head-to-head trial. Patients in different studies may differ in ways that affect patency (e.g., prevalence of thrombophilia, operator techniques, and follow-up rigor). Our sample size (N = 96) is moderate and only a small number of patency failures occurred, which makes estimates of differences imprecise. Another limitation is that we did not perform routine angiographic follow-up on all patients; patency was assessed noninvasively, so subclinical stenoses might have been missed, especially in patients who underwent TIPS for variceal bleeding. We relied on the need for intervention or complete occlusion as failure endpoints, which is standard in patency analysis but might slightly overestimate functional patency if mild stenoses were present. However, Doppler surveillance was frequent, making major undetected stenoses unlikely. We also acknowledge that our cohort's etiology mix (dominated by metabolic dysfunction–associated steatotic liver disease and alcohol) differs from some published cohorts (e.g., hepatitis B virus in Asia).[3] [8] Similarly, data from this study cannot be extrapolated to patients having noncirrhotic portal hypertension, especially those with Budd–Chiari syndrome in whom the patency rates of Niti-S stent have been shown to be relatively lower.[11] Additionally, longer follow-up (up to 5 years) is needed to ensure that Niti-S stents continue to perform well because one study has shown late divergence in the patency curve when using a generic stent graft (Fluency) compared with Viatorr.[7]

Conclusion

In our single-center experience, the Niti-S-covered stent demonstrated excellent medium-term durability that is on par with the best outcomes reported for the Viatorr TIPS endoprosthesis. The high patency of Niti-S translated into effective clinical control of variceal bleeding and ascites, with low re-intervention rates. These findings support the Niti-S stent as a viable alternative to the Viatorr, particularly in settings where cost or availability is an issue. Future comparative studies and longer term follow-up will further clarify the role of Niti-S and other generic-covered stents in the era of covered TIPS.

Conflict of Interest

None declared.

Ethical Approval

This study was approved by our institutional ethics committee (RHIEC).

Informed Consent

Written informed consent was obtained from each patient (or their caregiver) prior to the treatment.

• References

• 1 Lv Y, Wang Q, Luo B. et al. Identifying the optimal measurement timing and hemodynamic targets of portal pressure gradient after TIPS in patients with cirrhosis and variceal bleeding. J Hepatol 2025; 82 (02) 245-257
• 2 Jung HS, Kalva SP, Greenfield AJ. et al. TIPS: comparison of shunt patency and clinical outcomes between bare stents and expanded polytetrafluoroethylene stent-grafts. J Vasc Interv Radiol 2009; 20 (02) 180-185
• 3 Seo Y, Weon YC, Hwang JC. et al. Comparison of shunt patency and clinical outcomes between bare stents and expanded polytetrafluoroethylene-covered stents for transjugular intrahepatic portosystemic shunts. J Korean Soc Radiol 2013; 69 (02) 113-121
• 4 Bureau C, Garcia-Pagan JC, Otal P. et al. Improved clinical outcome using polytetrafluoroethylene-coated stents for TIPS: results of a randomized study. Gastroenterology 2004; 126 (02) 469-475
• 5 Vignali C, Bargellini I, Grosso M. et al. TIPS with expanded polytetrafluoroethylene-covered stent: results of an Italian multicenter study. AJR Am J Roentgenol 2005; 185 (02) 472-480
• 6 Yang Z, Han G, Wu Q. et al. Patency and clinical outcomes of transjugular intrahepatic portosystemic shunt with polytetrafluoroethylene-covered stents versus bare stents: a meta-analysis. J Gastroenterol Hepatol 2010; 25 (11) 1718-1725
• 7 Wu HM, Huang SQ, Wan YM, Li YH, Xu Y. Clinical outcomes of transjugular intrahepatic portosystemic shunt (TIPS) creation using fluency versus viatorr stent-grafts: a single-centre retrospective study. Cardiovasc Intervent Radiol 2022; 45 (05) 552-562
• 8 Wang Z, Wang J, Ye J. et al. Covered TIPS created with Viatorr versus fluency stent-grafts for the refractory ascites in patients with cirrhosis: an observational study. Acad Radiol 2025; 32 (09) 5112-5125
• 9 Saad WE, Darwish WM, Davies MG, Waldman DL. Stent-grafts for transjugular intrahepatic portosystemic shunt creation: specialized TIPS stent-graft versus generic stent-graft/bare stent combination. J Vasc Interv Radiol 2010; 21 (10) 1512-1520
• 10 Bai Y, Liu J, Wang C. et al. Comparison of specialized stent versus generic stent and bare stent combination for transjugular intrahepatic portosystemic shunt creation. Sci Rep 2024; 14 (01) 14439
• 11 Keshava SN, Moses V, Sharma A. et al. Technical and medium-term clinical outcomes of transjugular intrahepatic portosystemic shunt with fluoroscopy and additional trans-abdominal ultrasound guidance. Indian J Radiol Imaging 2021; 31 (04) 858-866
• 12 Sacks D, McClenny TE, Cardella JF, Lewis CA. Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol 2003; 14 (9, Pt 2): S199-S202
• 13 Angeli P, Gines P, Wong F. et al; International Club of Ascites. Diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the International Club of Ascites. Gut 2015; 64 (04) 531-537
• 14 European Association for the Study of the Liver. EASL clinical practice guidelines on TIPS. J Hepatol 2025; 83 (01) 177-210
• 15 Li W, Liu M, Guan S. et al. Comparison of outcomes for transjugular intrahepatic portosystemic shunt creation: Viatorr versus Fluency versus a bare stent/Fluency stent combination. CVIR Endovasc 2024; 7 (01) 76
• 16 Luo X, Zhao M, Wang X. et al. Long-term patency and clinical outcome of the transjugular intrahepatic portosystemic shunt using the expanded polytetrafluoroethylene stent-graft. PLoS One 2019; 14 (02) e0212658
• 17 Bercu ZL, Fischman AM, Kim E. et al. TIPS for refractory ascites: a 6-year single-center experience with expanded polytetrafluoroethylene-covered stent-grafts. AJR Am J Roentgenol 2015; 204 (03) 654-661
• 18 Gaba RC, Parvinian A. How quickly does ascites respond to TIPS? Clinical follow-up of a cohort of eighty patients. Diagn Interv Radiol 2014; 20 (04) 364

Publication History

Article published online:
29 October 2025