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LONG TERM PATENCY RATES FOR PATIENTS REQUIRING RECANALIZATION OR REVISION OF TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT (TIPS)

J Nazareno, C Dale, P Marotta
University of Western Ontario, London, Ontario

BACKGROUND: TIPS is a valuable tool in the management of portal hypertension (PHT). However, TIPS stenosis may occur leading to recurrent features of PHT and necessitating recanalization or revision of the shunt. Few studies have looked at the long term patency rates of patients who have required recanalization or revision of a TIPS.
METHODS: A retrospective chart review was performed on all patients undergoing TIPS recanalization or revision at our center. The main outcomes were patency rates at 3, 6, and 12 months post-revision. Secondary analyses were done to determine which patients were more likely to need repeat TIPS revision.
RESULTS: Between January 1994 and December 2005, 122 TIPS procedures were performed at our center with 21 (17%) needing at least one revision. Of these 21 the mean age was 50.5 years and 57.1% were women. The mean time from TIPS insertion to first revision was 8.1 months. The mean number of Doppler ultrasound studies from TIPS insertion to first revision was 2.9. Only 2 of 21 (9.5%) required a revision if the TIPS was patent at 1 year post insertion. The mean follow-up post-revision was 14.8 months. 52.3% of patients were symptomatic from the TIPS stenosis. TIPS revision allowed a change in mean gradient pre-revision of 16.4 mmHg to 6.2 mmHg. The average Childs-Pugh score was 8.2 pre-revision and 8.6 post-revision (p=ns).
Patency rates post-revision were 94.1%, 92.3%, and 87.5% at 3, 6, and 12 months, respectively. However, of those (n=7) who have follow-up of greater than 12 months post-revision, 57.1% required a repeat revision to maintain patency. Among the variables studied, the need for one revision was the only one found to be significant in predicting which patients would need another revision (p<0.0005). At the most recent follow-up 16 of 21 patients are alive. Cause of death did not include complications of TIPS.
CONCLUSIONS: Primary analysis shows that most TIPS (83%) remain patent without intervention. Patent TIPS at 1 year post insertion has a good patency prognosis. TIPS stenosis usually occurs within the first several months of insertion. Patency rates remain high (87.5%) even up to 12 months post-revision. Secondary analysis shows that a prior revision is a significant risk factor for requiring further revisions. Regardless, these patients can still enjoy long term patency of their TIPS.

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