Understanding the Impact of Initial TIPS Diameter in Patient Survival.

Monday, March 31, 2025

4:21 PM – 4:30 PM CT

Location: Music City Center, 204

Author/Co-author(s)

Megan K. H Powell

Medical Student
University of Virginia School of Medicine, United States

Presenting Author(s)

Warren A. Campbell, IV, MD, PhD

Resident
University of Virginia School of Medicine, United States

Author/Co-author(s)

JP

James Patrie, MS

Senior Biostatistician
University of Virginia School of Medicine, United States
J. Fritz F. Angle, MD

Director of Interventional Radiology
Department of Radiology and Medical Imaging, University of Virginia, United States
Luke R. Wilkins, MD, FSIR

Associate Professor
University of Virginia, United States
Daniel Sheeran, MD

Associate Professor
University of Virginia, United States

Purpose: Transjugular Intrahepatic Portosystemic Shunt (TIPS) is a minimally invasive procedure for portal decompression. TIPS can have complications rates ranging up to 20% with a high rate of morbidity and mortality. In the setting of critically low portosystemic gradients with rising bilirubin, hepatic encephalopathy, and rising liver function studies requires shunt caliber reduction. We investigate the role of TIPS controlled expansion stent graft diameter on overall survival, transplant-free survival, and risk of reintervention.

Materials and Methods: A single-center retrospective review was conducted on 187 adult patients (78 females, mean age 57.5 ± 10.8 years) with TIPS placement between January 2018 and December 2022. Pre-procedural data collected include patient demographics, TIPS indication, and liver disease etiology. Post procedural data including clinical status, diagnostic ultrasonography, reinterventions, and time to liver transplantation, were analyzed at 1, 3, 6, 12, 24, 36, and 48 months.

Results: 187 TIPS procedures were performed, 131 (70.1%) were elective, 49 (26.2%) urgent, and 7 (3.7%) emergent. There was no correlation between diameter size and TIPS reduction at these diameters (P = 0.47). Median post-TIPS survival was 46.2 months, with 85 deaths (45.5%) from all-causes during follow-up. Survival with 8mm, 9mm, and 10mm diameter stent was 46.1, 52.5, 46.2 months, respectively. There was no statistically significant correlation of stent diameter and overall survival (P = 0.838). Multiple Cox proportional hazard regression adjusted hazard ratios for modeling overall survival as a function of final TIPS diameter (mm) adjusting for age, gender, liver disease cause, primary indication, and TIPS urgency showed no significant correlation between 8mm and 9mm (P= 0.489), 9mm and 10mm (P=0.847), or 8mm and 10mm (P=0.748). Similarly, stent graft diameter was not correlated to transplant-free survival, with overall median transplant free survival of 24 months compared to 8mm, 9mm, and 10mm diameter transplant free survival of 23.6 months (95% CI: [17.1, 37.2 months]), 8.7 months (95% CI: [2.3, 53.0], 46.2 months (95% CI: [1.4, NA]. P = 0.384 respectively.

Conclusion: Comparing controlled expansion endoprosthesis TIPS graft diameter of 8mm, 9mm, and 10mm did not impact median overall survival or transplant-free survival.