SIR 2024
Portal Hypertension
Ryan M. Kiefer, MD (he/him/his)
Resident
HUP
Financial relationships: Full list of relationships is listed on the CME information page.
Daniel M. DePietro, MD
Assistant Professor
Perelman School of Medicine at the University of Pennsylvania
Financial relationships: Full list of relationships is listed on the CME information page.
Susan Shamimi-Noori, MD
Associate Professor
University of Pennsylvania
Disclosure information not submitted.
Jeffrey Mondschein, MD
Associate Professor of Clinical Radiology
University of Pennsylvania
Disclosure information not submitted.
Mandeep Dagli, MD
Associate Professor of Radiology
Hospital of the University of Pennsylvania
Disclosure information not submitted.
Maxim Itkin, MD, FSIR (he/him/his)
Professor of Radiology
Perelman School of Medicine at the University of Pennsylvania, Hospital of the University of Pennsylvania
Financial relationships: Full list of relationships is listed on the CME information page.
Timothy W. I. Clark, MD, MSc
Attending Physician
Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
Disclosure information not submitted.
William Stavropoulos, MD, FSIR
Professor of Radiology
University of Pennsylvania
Disclosure information not submitted.
Richard D. Shlansky-Goldberg, MD
Professor of Radiology
Perelman School of Medicine at the University of Pennsylvania, Hospital of the University of Pennsylvania
Disclosure information not submitted.
Scott O. Trerotola, MD
Associate Chair and Chief, Interventional Radiology
Perelman School of Medicine at the University of Pennsylvania, Hospital of the University of Pennsylvania
Financial relationships: Full list of relationships is listed on the CME information page.
Michael C. Soulen, MD
Professor
Perelman School of Medicine at the University of Pennsylvania, Hospital of the University of Pennsylvania
Disclosure information not submitted.
Gregory J. Nadolski, MD
Associate Professor
Hospital of the University of Pennsylvania, Department of Interventional Radiology
Financial relationships: Full list of relationships is listed on the CME information page.
Transjugular intrahepatic portosystemic shunts (TIPS) have good long-term primary assisted patency rates, reported at 78% at 6 years {1}. When TIPS occlusion (defined as complete thrombosis of the TIPS or cessation of flow through the TIPS due to another cause) occurs, patency can be restored with a variety of interventions. The purpose of this study was to characterize treatment techniques and outcomes of TIPS revision performed to restore patency after TIPS occlusion.
Materials and methods:
Between 2000-2023, 508 TIPS revision procedures were identified, of which 75 (15%) were performed for TIPS occlusion in 58 patients (39 male/19 female; mean age 57 ± 12 years). Data regarding initial TIPS creation, treatment technique for restoration of TIPS patency, and patient outcomes were retrospectively collected.
Results: Date of TIPS creation was known in 37 patients (64%) and initial TIPS occlusion occurred at a median of 4 (range 1-117) months after creation. TIPS patency was successfully restored during the initial attempt in 49 patients (84%) and upon repeated attempt in 3 additional patients. In total, TIPS patency was able to be restored in 52 patients (90%). Of those with restored patency, long-term follow-up was available in 43/51 patients (84%). Median TIPS patency was 4 (range 0-100) months after intervention and 14 patients (24%) had recurrent TIPS occlusion. Of the 75 total cases performed to treat TIPS occlusion, 58 (77%) utilized balloon maceration and angioplasty to restore TIPS patency, a thrombectomy device was used in 19 cases (25%), and a new stent or stent-graft was placed in 63% (47/75).
Conclusion: Complete TIPS occlusion represents an important subgroup of patients presenting for TIPS revision. TIPS patency can be restored in most patients through techniques including PTA and additional stent placement with durable results.