Use of fenestration to revise shunt dysfunction after transjugular intrahepatic portosystemic shunt

  • Zhaonan Li
  • De-Chao Jiao
  • Guangyan Si
  • Xinwei HanEmail author
  • Wenguang Zhang
  • Yahua Li
  • Xueliang Zhou
  • Juanfang Liu
  • Jianjian Chen
Interventional Radiology



To explore the feasibility of fenestration in the treatment of shunt dysfunction after transjugular intrahepatic portosystemic shunt (TIPS).


Between February 2012 and December 2017, 12 TIPS patients with shunt dysfunction underwent fenestration to resolve recurrent portal hypertension with gastric variceal bleeding or ascites. The demographic data, operative data, postoperative recovery data, hemodynamic data, and complications were analyzed.


Twelve patients underwent TIPS revision by fenestration, with a technical success rate of 100%. After stent reconstruction, the portal vein diameters decreased gradually with time (before the procedure: at 5 days/1 month/3 months/6 months; after procedure: 1.45 ± 0.11 cm/1.38 ± 0.06 cm/1.36 ± 0.05 cm/1.34 ± 0.05 cm/1.32 ± 0.06 cm, respectively, P = 0.057). Additionally, the blood flow velocity and blood flow rapidly increased in the portal veins and shunts after TIPS revision (P < 0.001). Surprisingly, after 3 months of stent reconstruction, the portal blood flow was 4607.99 ± 1304.10 mL/min which was even lower than the shunt flow at 4651.18 ± 612.74 mL/min. The mean pressure gradient (PSG) prior to TIPS revision was 36.71 ± 3.36 mmHg which decreased to 17.42 ± 3.37 mmHg after the procedure (P < 0.001). Clinical improvement was observed in all patients after the shunt reconstruction. Three patients (25%) had mild intra-abdominal hemorrhage at 1 week after the operation. After a mean 11.0 ± 1.24 months follow-up, ascites and bleeding were well controlled, and no stenosis of the stents was found.


For patients with failed TIPS revision, fenestration to reconstruct the shunt provides an excellent alternative procedure, which is effective, safe, and has a certain clinical value, for continuing the treatment of portal hypertension.


Portal hypertension Hepatic encephalopathy Cirrhosis Portography 



Transjugular intrahepatic portosystemic shunt


Portal vein thrombosis


Recurrent variceal bleeding


Portosystemic gradient


Inferior vena cava


Recurrent variceal bleeding


b-Hepatitis cirrhosis


Alcoholic cirrhosis


Portal vein


Refractory ascites


Hepatic encephalopathy


Fluency stent (Bard, Voisins le Bretonneux, France)


Viatorr stent (Gore & Associates, Flagstaff, AZ, USA)


Wall stent (Boston Scientific, Natick, MA, USA)


Direct intrahepatic portacaval shunt


expanded polytetrafluoroethylene



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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Interventional RadiologyFirst Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
  2. 2.Department of Interventional RadiologyThe Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical UniversityLuzhouChina
  3. 3.Institute of Interventional RadiologyFirst Affiliated Hospital of Zhengzhou UniversityZhengzhouChina

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