Meyer Carsten, Kimmann Markus, Böhm Katharina, Nowak Sebastian, Pérez Alba Maria Paar, Meier Jörn Arne, Reinartz Groba Sara Noemi, Gödiker Juliana, Uschner Frank Erhard, Sanoubara Feras, Chang Johannes, Trebicka Jonel, Sprinkart Alois Martin, Praktiknjo Michael
Department of Diagnostic and Interventional Radiology, University of Bonn, Bonn, Germany.
Department of Internal Medicine B, University of Münster, Münster, Germany.
Aliment Pharmacol Ther. 2025 Jun;61(11):1805-1814. doi: 10.1111/apt.70133. Epub 2025 Apr 9.
Patients with decompensated cirrhosis are at risk of portal hypertension-related complications, such as refractory ascites or variceal bleeding. Transjugular intrahepatic portosystemic shunt (TIPS) insertion is the most effective treatment to reduce portal hypertension. However, patients are at risk for TIPS dysfunction.
We aimed to investigate the prognostic value of three-dimensional (3D) TIPS geometry in predicting TIPS dysfunction.
A total of 107 patients who underwent TIPS insertion between 2014 and 2019 and received a computed tomography (CT) scan after TIPS insertion during routine clinical practice were included. We used a semiautomated algorithm and multiplanar reconstructions of these CT scans to calculate parameters of 3D TIPS geometry. The primary outcome of this study was the development of TIPS dysfunction (defined as need for invasive TIPS revision). To identify predictors for the development of TIPS dysfunction, Cox regression analyses were performed with TIPS dysfunction as the endpoint.
Thirty-two patients developed TIPS dysfunction and were compared to the dysfunction-free 75 patients. A larger distance from the cranial TIPS stent end to the vena cava inferior (p < 0.001, HR 1.061, 95% CI 1.030-1.093) and the maximum stent curvature (p = 0.003, HR 1.020, 95% CI 1.007-1.034) were significantly associated with TIPS dysfunction in a multivariate Cox regression analysis.
A more pronounced stent curvature and a longer cranial stent distance from the inferior vena cava were identified as independent predictors of TIPS dysfunction. Interventionalists should choose a more central and less curved TIPS tract during the TIPS procedure to reduce the risk of development of TIPS dysfunction.
This retrospective monocentric study includes patients from the NEPTUN cohort (registered at ClinicalTrials.gov; Identifier: NCT03628807).
失代偿期肝硬化患者有发生门静脉高压相关并发症的风险，如顽固性腹水或静脉曲张出血。经颈静脉肝内门体分流术（TIPS）置入是降低门静脉高压最有效的治疗方法。然而，患者存在TIPS功能障碍的风险。
我们旨在研究三维（3D）TIPS几何形状在预测TIPS功能障碍方面的预后价值。
纳入2014年至2019年间接受TIPS置入并在常规临床实践中于TIPS置入后接受计算机断层扫描（CT）的107例患者。我们使用半自动算法和这些CT扫描的多平面重建来计算3D TIPS几何形状的参数。本研究的主要结局是TIPS功能障碍的发生（定义为需要进行侵入性TIPS修复）。为了确定TIPS功能障碍发生的预测因素，以TIPS功能障碍为终点进行Cox回归分析。
32例患者发生TIPS功能障碍，并与75例无功能障碍的患者进行比较。在多变量Cox回归分析中，从TIPS支架头端到下腔静脉的距离较大（p<0.001，HR 1.061，95%CI 1.030-1.093）和最大支架曲率（p=0.003，HR 1.020，95%CI 1.007-1.034）与TIPS功能障碍显著相关。
更明显的支架曲率和TIPS支架头端距下腔静脉更长的距离被确定为TIPS功能障碍的独立预测因素。介入医生在TIPS手术过程中应选择更居中且弯曲度较小的TIPS路径，以降低发生TIPS功能障碍的风险。
这项回顾性单中心研究纳入了NEPTUN队列的患者（在ClinicalTrials.gov注册；标识符：NCT03628807）。
