Percutaneous revision of dysfunctional shunts in patients who underwent intrahepatic portosystemic shunt procedure via percutaneous or conventional method: 11-years single center experience.

Background And Aim: Our primary objective is to report the results of the ultrasound (US)-guided revision technique of transhepatic shunt in patients in whom intrahepatic portosystemic shunt was created by the percutaneous or conventional route. Our secondary objective is to investigate whether there is an association between the indication for a portosystemic shunt and the need for post-shunt revision.

Methods: Data from 117 consecutive patients who had a transjugular intrahepatic portosystemic shunt placed percutaneously or conventionally were extracted from hospital electronic medical records and examined those who underwent revision within 11 years and those who did not. US-guided transhepatic shunt revision technique was evaluated in terms of technical success, complications, and patency. In addition, the relationship between etiology and the need for revision was also examined using the chi-square test in three groups.

Results: Forty six point two percent of patients who underwent transjugular intrahepatic portosystemic shunt required one or more revisions within 11 years. While patency of the shunt could be established via the transjugular route in 83.3% of revision patients, it was necessary to use the transhepatic route in 16.7%. The technical success rate for the US-guided transhepatic shunt revision method was 100%, and the pressure gradient between the portal and hepatic venous systems decreased below 10 mmHg in all patients at the end of the procedure.

Conclusion: US-guided transhepatic shunt revision is a safe and effective method where transjugular revision cannot be performed. In addition, the revision rate is significantly higher in patients who have undergone transjugular intrahepatic portosystemic shunt due to Budd-Chiari syndrome compared with other groups.