Skip to main content

Clinical Outcomes of Transjugular Intrahepatic Portosystemic Shunt (Tips) Creation Using Fluency Versus Viatorr Stent-Grafts: A Single-Centre Retrospective Study

CardioVascular and Interventional Radiology volume 45, pages 552–562 (2022)Cite this article

Abstract

Purpose

To investigate the effects of transjugular intrahepatic portosystemic shunt (TIPS) creation using Fluency versus Viatorr stent-grafts on the long-term clinical outcomes.

Materials and Methods

This was a single-center retrospective study from January 2010 to October 2021 in 213 patients receiving TIPS with Fluency (Fluency group, n = 154) versus Viatorr (Viatorr group, n = 59) stent-grafts. Inclusion criteria were: age > 18 years old and TIPS creation for variceal hemorrhage. Exclusion criteria were: age > 80 years old, concomitant chronic heart or lung disease, active tuberculosis or human immunodeficiency virus infection, extrahepatic malignancy, alcohol dependence, TIPS created outside of our hospital, without any follow-up data, or decline to participate. The primary outcome was primary patency rate and its associated risk factors.

Results

The 5-year cumulative primary patency rate was significantly higher in Viatorr group than in Fluency group (89.0% vs. 19.6%, p < 0.001), whereas the 5-year cumulative transplant-free survival rate (62.3% vs. 62.2%, p = 0.636) was comparable between two groups. Cox-regression models revealed that group (hazard ratio [HR]4.029, 95% confidence interval [CI] 1.486–10.927, p = 0.006), use of bare stents (HR 3.307, 95% CI 1.903–5.747, p < 0.001), and baseline portal vein thrombosis (HR 0.248, 95% CI 0.149–0.412, p < 0.001) were significantly associated with shunt patency. Incidences of adverse events were not significantly different between two groups (p > 0.05).

Conclusions

TIPS creation using Viatorr stent-grafts is superior to using Fluency stent-grafts in terms of higher long-term primary patency rate but similar transplant-free survival rate.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Abbreviations

TIPS:

Transjugular intrahepatic portosystemic shunt

ePTFE:

Expanded polytetrafluoroethylene

HR:

Hazard ratio

CI:

Confidence interval

HE:

Hepatic encephalopathy

CT:

Computed tomography

PVT:

Portal vein thrombosis

PTA:

Percutaneous angioplasty

CTP:

Child–Turcotte–Pugh

MELD:

Model for end-stage liver disease

HBV:

Hepatitis B virus

PT:

Prothrombin time

INR:

International normalized ratio

AST:

Aspartate aminotransferase

WBC:

White blood cell counts

PPG:

Portal venous pressure gradient

References

  1. Qi X, Tian Y, Zhang W, Yang Z, Guo X. Covered versus bare stents for transjugular intrahepatic portosystemic shunt: an updated meta-analysis of randomized controlled trials. Therap Adv Gastroenterol. 2017;10:32–41.

    Article  PubMed  Google Scholar 

  2. Cejna M. Should stent-grafts replace bare stents for primary transjugular intrahepatic portosystemic shunts? Semin Intervent Radiol. 2005;22:287–99.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Yang Z, Han G, Wu Q, Ye X, Jin Z, Yin Z, 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;25:1718–25.

    Article  PubMed  Google Scholar 

  4. Lin ZP, Zhao JB, Chen SL. Analysis of the medium-term curative effect of transjugular intrahepatic portosystemic shunt through jugular vein with covered Viatorr stent. Zhonghua Gan Zang Bing Za Zhi. 2019;27:440–4 (Chinese).

    CAS  PubMed  Google Scholar 

  5. Ferral H, Gomez-Reyes E, Fimmel CJ. Post-transjugular intrahepatic portosystemic shunt follow-up and management in the VIATORR Era. Tech Vasc Interv Radiol. 2016;19:82–8.

    Article  PubMed  Google Scholar 

  6. Sommer CM, Gockner TL, Stampfl U, Bellemann N, Sauer P, Ganten T, et al. Technical and clinical outcome of transjugular intrahepatic portosystemic stent shunt: bare metal stents (BMS) versus viatorr stent-grafts (VSG). Eur J Radiol. 2012;81:2273–80.

    Article  PubMed  Google Scholar 

  7. 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;21:1512–20.

    Article  PubMed  Google Scholar 

  8. Wan YM, Li YH, Xu ZY, Wu HM, Wu XN, Xu Y. Comparison of TIPS alone and combined with partial splenic embolization (PSE) for the management of variceal bleeding. Eur Radiol. 2019;29:5032–41.

    Article  PubMed  Google Scholar 

  9. Wan YM, Li YH, Xu Y, Wu HM, Li YC, Wu XN, et al. Predictors of shunt dysfunction and overall survival in patients with variceal bleeding treated with transjugular portosystemic shunt creation using the fluency stent graft. Acad Radiol. 2018;25:925–34.

    Article  PubMed  Google Scholar 

  10. Maschke SK, Werncke T, Renne J, Kloeckner R, Marquardt S, Kirstein MM, et al. Transjugular intrahepatic portosystemic shunt (TIPS) dysfunction: quantitative assessment of flow and perfusion changes using 2D-perfusion angiography following shunt revision. Abdom Radiol (NY). 2018;43:2868–75.

    Article  Google Scholar 

  11. Perello MP, Mur JP, Vives MS, Riutort JMM, Artigues AP, Garcia CN, et al. Long-term follow-up of transjugular intrahepatic portosystemic shunt (TIPS) with stent-graft. Diagn Interv Radiol. 2019;25:346–52.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Schuppan D, Afdhal NH. Liver cirrhosis. Lancet. 2008;371:838–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Lv Y, He C, Wang Z, Guo W, Wang J, Bai W, et al. Association of nonmalignant portal vein thrombosis and outcomes after transjugular intrahepatic portosystemic shunt in patients with cirrhosis. Radiology. 2017;285:999–1010.

    Article  PubMed  Google Scholar 

  14. Takaya H, Uemura M, Fujimura Y, Matsumoto M, Matsuyama T, Kato S, et al. ADAMTS13 activity may predict the cumulative survival of patients with liver cirrhosis in comparison with the child-turcotte-pugh score and the model for end-stage liver disease score. Hepatol Res. 2012;42:459–72.

    Article  PubMed  Google Scholar 

  15. Vilstrup H, Amodio P, Bajaj J, Cordoba J, Ferenci P, Mullen KD, et al. Hepatic encephalopathy in chronic liver disease: 2014 practice guideline by the American association for the study of liver diseases and the European association for the study of the liver. Hepatology. 2014;60:715–35.

    Article  PubMed  Google Scholar 

  16. Klinger C, Riecken B, Müller J, Westphal A, Löffler J, Froehlich E, et al. Doppler ultrasound surveillance of TIPS-patency in the era of covered stents - retrospective analysis of a large single-center cohort. Z Gastroenterol. 2018;56:1053–62.

    Article  PubMed  Google Scholar 

  17. Zhou H, Yao X, Tang SH, Xie M, Feng ZS, Qin JP. Clinical study of transjugular intrahepatic portosystemic shunt with Viatorr stent in 43 cases. Zhonghua Gan Zang Bing Za Zhi. 2021;29:54–9 (Chinese).

    CAS  PubMed  Google Scholar 

  18. Jalan R, Hayes PC, Redhead DN. Shunt insufficiency after TIPSS. Cardiovasc Intervent Radiol. 1998;21:187–8.

    Article  CAS  PubMed  Google Scholar 

  19. Perarnau JM, Le Gouge A, Nicolas C, d’Alteroche L, Borentain P, Saliba F, et al. Covered vs. uncovered stents for transjugular intrahepatic portosystemic shunt: a randomized controlled trial. J Hepatol. 2014;60:962–8.

    Article  PubMed  Google Scholar 

  20. Qi X, He C, Guo W, Yin Z, Wang J, Wang Z, et al. Transjugular intrahepatic portosystemic shunt for portal vein thrombosis with variceal bleeding in liver cirrhosis: outcomes and predictors in a prospective cohort study. Liver Int. 2016;36:667–76.

    Article  PubMed  Google Scholar 

  21. Qi X, Guo W, He C, Zhang W, Wu F, Yin Z, et al. Transjugular intrahepatic portosystemic shunt for Budd-Chiari syndrome: techniques, indications and results on 51 Chinese patients from a single centre. Liver Int. 2014;34:1164–75.

    Article  PubMed  Google Scholar 

  22. Bai M, Qi X, Yang Z, Yin Z, Nie Y, Yuan S, et al. Predictors of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in cirrhotic patients: a systematic review. J Gastroenterol Hepatol. 2011;26:943–51.

    Article  PubMed  Google Scholar 

  23. Billey C, Billet S, Robic MA, Cognet T, Guillaume M, Vinel JP, et al. A prospective study identifying predictive factors of cardiac decompensation after transjugular intrahepatic portosystemic shunt: the Toulouse algorithm. Hepatology. 2019;70:1928–41.

    Article  PubMed  Google Scholar 

  24. Busk TM, Bendtsen F, Poulsen JH, Clemmesen JO, Larsen FS, Goetze JP, et al. Transjugular intrahepatic portosystemic shunt: impact on systemic hemodynamics and renal and cardiac function in patients with cirrhosis. Am J Physiol Gastrointest Liver Physiol. 2018;314:G275–86.

    Article  PubMed  Google Scholar 

  25. Praktiknjo M, Abu-Omar J, Chang J, Thomas D, Jansen C, Kupczyk P, et al. Controlled underdilation using novel VIATORR® controlled expansion stents improves survival after transjugular intrahepatic portosystemic shunt implantation. JHEP Rep. 2021;3:100264.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Author notes

  1. Hua-Mei Wu, Song-Quan Huang have Contributed equally to this study.

Authors and Affiliations

  1. Gastroenterology Department II, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, Yunnan, China

    Hua-Mei Wu, Yue-Meng Wan, Yu-Hua Li & Ying Xu

  2. Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, Yunnan, China

    Song-Quan Huang

Authors
  1. Hua-Mei Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Song-Quan Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yue-Meng Wan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yu-Hua Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ying Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Hua-Mei Wu, Song-Quan Huang: patient management and follow-up; acquisition of data; drafting manuscript. Yu-Hua Li: patient management and follow-up; acquisition of data. Yue-Meng Wan: study concept and design; statistical analysis and interpretation; draft revison; critical revision of the manuscript for important intellectual content. Ying Xu: study design; administrative, technical, or material support; study coordination and supervision.

Corresponding author

Correspondence to Yue-Meng Wan.

Ethics declarations

Conflicts of interest

All authors including Hua-Mei Wu, Song-Quan Huang, Yue-Meng Wan, Yu-Hua Li, Ying Xu declared no conflict of interest.

Ethical Approval

This study was approved by our institutional ethics committee and conformed to the Helsinki Declaration of 1975, as revised in 2008.

Informed Consent

Individual written informed consents for the TIPS procedures were obtained from all patients or their authorized trustees.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (JPG 597 KB)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Wu, HM., Huang, SQ., Wan, YM. et al. Clinical Outcomes of Transjugular Intrahepatic Portosystemic Shunt (Tips) Creation Using Fluency Versus Viatorr Stent-Grafts: A Single-Centre Retrospective Study. Cardiovasc Intervent Radiol 45, 552–562 (2022). https://doi.org/10.1007/s00270-022-03102-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-022-03102-5

Keywords

  • Transjugular intrahepatic portosystemic shunt
  • Fluency stent-grafts
  • Viatorr stent-grafts
  • Shunt patency
  • Transplant-free survival