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

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Abstract

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.

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Data Availability

Not applicable.

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Acknowledgements

No one other than the authors of this article contributed to this study.

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Authors and Affiliations

  1. Faculty of Medicine, Department of Radiology, Interventional Radiology Section, Başkent University, Ankara Hospital, Yukarı Bahçelievler district, Mareşal Fevzi Çakmak Ave. 10. Street, No:45, Çankaya, 06490, Ankara, Turkey

    Özgür Özen, Fatih Boyvat, Tolga Zeydanlı & Pelin Kaya

  2. Faculty of Medicine, Department of Radiology, Interventional Radiology Section, Başkent University, Konya Hospital, Hocacihan district, Saray Ave., No:1, Selçuklu, 42080, Konya, Turkey

    Çağrı Kesim

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  1. Özgür Özen
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  2. Fatih Boyvat
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  3. Çağrı Kesim
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  4. Tolga Zeydanlı
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  5. Pelin Kaya
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Contributions

Özgür Özen, MD - Conceptualization; Data curation; Formal analysis. Fatih Boyvat, MD - Supervision; Validation; Visualization. Çağrı Kesim, MD - Project Administration, Writing - original draft; Writing - review & editing. Tolga Zeydanlı, MD - Resources; Software. Pelin Kaya, MD - Investigation; Methodology.

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Correspondence to Çağrı Kesim.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required. This study was approved by Başkent University Institutional Review Board (Project no: KA23/21).

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This study has obtained IRB approval from Başkent University, and the need for informed consent was waived.

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For this type of study, consent for publication is not required.

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The authors declare that they have no conflict of interest.

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Highlights

• If the transjugular approach fails, the transhepatic approach is useable.

• Percutaneous TIPS revisions can be performed safer under ultrasound guidance.

• The ultrasound-guided puncture for TIPS revisions were technically 100% successful.

• No complications occurred during any of the operations.

• The need for revision is higher in the Budd-Chiari patient group than in others.

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Özen, Ö., Boyvat, F., Kesim, Ç. et al. Percutaneous revision of dysfunctional shunts in patients who underwent intrahepatic portosystemic shunt procedure via percutaneous or conventional method: 11-years single center experience. Ir J Med Sci 192, 2755–2761 (2023). https://doi.org/10.1007/s11845-023-03390-x

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