Transjugular intrahepatic portosystemic shunt with ePTFE-covered stentgrafts: incidence and predictors of shunt dysfunction.

objectivesTo analyze revision rates after transjugular intrahepatic portosystemic shunt (TIPS) using expanded polytetrafluoroethylene-covered stentgrafts and to identify predictors of shunt revisions. MATERIALS AND

methodsThis single-center retrospective study included 514 consecutive patients (mean age 56.9 ± 12.7 years; 194 females) with TIPS placement between 2003 and 2021. Follow-up included clinical assessment, laboratory testing, ultrasound, and computed tomography. Reinterventions were categorized by type and technique. Univariable and multivariable Cox regression analyses were performed to identify predictors of shunt dilation and reduction.

resultsA total of 149 patients (28.9%) required TIPS revision: 95 (18.5%) shunt dilation, 42 (8.2%) shunt reduction, and 12 (2.3%) others. Median time to first revision was 2.8 months (3.2 months for dilation, 1.9 months for reduction). Indications for first shunt dilation were persistent or recurrent refractory ascites (n = 61), recurrent variceal bleeding (n = 7), and asymptomatic stenosis or occlusion of the TIPS tract (n = 27). Indications for shunt reduction were hepatic encephalopathy refractory to conservative measures (n = 39) and acute liver failure following TIPS (n = 3). Forty-seven patients (9.1%) underwent two or more reinterventions. Multivariable Cox analysis identified immediate post-TIPS portosystemic pressure gradients > 8 mmHg, prior hepatic encephalopathy, and hepatorenal syndrome prior to TIPS as predictors of mandatory shunt dilation. In contrast, age ≥ 65 years, female gender, serum sodium levels, and a pre-TIPS hepatic hydrothorax were predictive of shunt reduction during revision.

conclusionAround one in three patients requires shunt revision. Predictive factors for revision varied by intervention type: shunt dilation was linked to disease severity and portal pressure, whereas reduction was more closely related to the patient's age and gender. CRITICAL RELEVANCE STATEMENT: Patients who undergo TIPS require structured, long-term follow-up to identify clinical situations that may necessitate shunt adaptation or other secondary interventions. KEY POINTS: Shunt revision after TIPS occurs in one-third of patients, with prognostic significance. Several independent prognostic factors for both shunt dilation and reduction were identified. Structured long-term follow-up is crucial to identify patients needing shunt revision.