Stent dysfunction after transjugular intrahepatic portosystemic shunt: Causes and countermeasures

Objective To investigate the causes of dysfunction of COOK bare stent, Wallgraft covered stent, and Fluency covered stent after transjugular intrahepatic portosystemic shunt ( TIPS) and related countermeasures. Methods The clinical data of 54 patients who were found to have stent dysfunction and underwent TIPS correction in our hospital from January 2011 to July 2017 were collected. Balloon dilatation, coaxial stent implantation, or parallel TIPS was selected based on angiography results and portal venous pressure to repair stent dysfunction. The Kruskal-Wallis H test was used to compare in-stent restenosis or occlusion time between the three types of stents, and the paired t-test was used to compare portal vein perfusion ( PVP) before and after correction. Radiological examination was performed to evaluate stent dysfunction, and the cause of in-stent restenosis or occlusion was analyzed. Results TIPS correction was successfully performed for all 54 patients. Stenosis was observed in the hepatic vein, the liver parenchyma, or the portal vein, and there was a high incidence rate within 6-24 months after surgery. The median time to stenosis or occlusion was 17. 0 months for COOK bare stent, 10. 0 months for Wallgraft covered stent, and 17. 0 months for Fluency covered stent. COOK bare stent and Fluency covered stent had a longer time to stenosis or occlusion than Wallgraft covered stent ( P = 0. 013 and 0. 023) , and there was no significant difference in the time to stenosis or occlusion between COOK bare stent and Fluency covered stent ( P = 0. 893) . As for the surgical procedure of TIPS correction, 4 patients underwent balloon dilatation, 39 underwent coaxial stent implantation, and 11 underwent parallel TIPS. There was a significant reduction in portal venous pressure after surgery ( 25. 6 ± 4. 8 cm H2O vs 34. 7 ± 6. 4 cm H2O, P < 0. 001) . Conclusion Wallgraft stent has a significantly shorter time to stent dysfunction after TIPS than COOK bare stent and Fluency covered stent, suggesting that Wallgraft stent is not suitable for the initial establishment of TIPS shunt. Correction procedures should be selected based on actual conditions to repair stent dysfunction and restore shunt patency.