Selection of transjugular intrahepatic portosystemic shunt stents for controlling portal hypertension

Background: Nowadays, transjugular intrahepatic portosystemic shunt (TIPS) has become a mainstay treatment option for the management of portal hypertension-related complications in liver cirrhosis. Accumulated evidence has shown that its indications are being gradually expanded. Notwithstanding, less attention has been paid for the selection of an appropriate stent during a TIPS procedure. Aim: To evaluate efficacy of transjugular intrahepatic portosystemic shunt stent for decreasing portal pressure and estimate stent diameter according to the classification and patient condition. Materials and Methods: We observed and surveyed 67 patients between 2002 and 2014, 67 patients with cirrhosis (60 males) with a mean age 51.08±12.574 years underwent TIPS in the Tashkent Medical Academy II clinic (18 patients) and Chonnam National University Hospital (49 patients) who underwent TIPS. 17 patients were infected with hepatitis B virus, 6 patients were with hepatitis C, 1 patient were diagnosed with both of HBV, HCV, and histiocytosis. In 2 patients developed cirrhosis cause of both alcohol and hepatitis B virus. The hepatic function status evaluated by Child-Pugh classification. Results: We compared patients’ condition and complications of the TIPS according to stent diameter. The first month mortality rate was higher in the 12-mm stent group than in the 10-mm stent group. The 10 mm stents were more effective than the 8 mm stents for reducing portosystemic pressure gradient after TIPS (6.5±2.7 mm Hg and 8.9±2.7 mm Hg, P=0.007). A 10-mm stent group was superior to the 8-mm stent group for decreasing the first year rate of remaining free of recurrence and/or persistence of complications due to portal hypertension (82.9% and 41.9%, P = 0.002, by Log-Rank test). Conclusion: The study showed that a 10-mm stent might be effective and brought less complication than an 8-mm or 12-mm stent for the management of PH and the development of shunt patency. Covered stents are better than bare stents for decreasing the shunt dysfunction. The placement of a stent in the left portal vein branch may enhance the hepatic perfusion and decrease the incidence of hepatic encephalopathy.