Effect of initial stent position on patency of transjugular intrahepatic portosystemic shunt.

Aim: To evaluate the effect of initial stent position on transjugular intrahepatic portosystemic shunt (TIPS).

Methods: We studied 425 patients from January 2004 to January 2015 with refractory ascites or variceal bleeding who required TIPS placement. Patients were randomly divided into group A (stent in hepatic vein, = 57), group B (stent extended to junction of hepatic vein and inferior vena cava, = 136), group C (stent in left branch of portal vein, = 83) and group D (stent in main portal vein, = 149). Primary unassisted patency was compared using Kaplan-Meier analysis, and incidence of recurrence of bleeding, ascites and hepatic encephalopathy (HE) were analyzed.

Results: The mean primary unassisted patency rate in group B tended to be higher than in group A at 3, 6 and 12 mo ( = 0.001, 0.000 and 0.005), and in group D it tended to be lower than in group C at 3, 6 and 12 mo ( = 0.012, 0.000 and 0.028). The median shunt primary patency time for group A was shorter than for group B (5.2 mo 9.1 mo, 95%CI: 4.3-5.6, = 0.013, log-rank test), while for group C it was longer than for group D (8.3 mo 6.9 mo, 95%CI: 6.3-7.6, = 0.025, log-rank test). Recurrence of bleeding and ascites in group A was higher than in group B at 3 mo ( = 0.014 and 0.020), 6 mo ( = 0.014 and 0.019) and 12 mo ( = 0.024 and 0.034. Recurrence in group D was higher than in group C at 3 mo ( = 0.035 and 0.035), 6 mo ( = 0.038 and 0.022) and 12 mo ( = 0.017 and 0.009). The incidence of HE was not significantly different among any of the groups ( = 0.965).

Conclusion: The initial stent position can markedly affect stent patency, which potentially influences the risk of recurrent symptoms associated with shunt stenosis or occlusion.