CardioVascular and Interventional Radiology

, Volume 41, Issue 11, pp 1794–1798 | Cite as

Transjugular Intrahepatic Portosystemic Shunt Through the Strut of a Previously Placed Stent: Technical Feasibility and Long-Term Follow-Up Results

  • Munawwar AhmedEmail author
  • Shyamkumar Nidugala Keshava
  • Vinu Moses
  • George Koshy Chiramel
  • Suraj Mammen
  • C. E. Eapen
  • Uday George Zachariah
Technical Note
Part of the following topical collections:
  1. TIPS


Aims and Objectives

To evaluate technical feasibility, long-term primary patency and clinical outcome of the transjugular intrahepatic portosystemic shunt (TIPS) through the struts of the previously placed stents.

Materials and Methods

Retrospective evaluation of seven consecutive patients (three male and four female, age range 13–65 years, median 28) out of a total 95 patients, who underwent TIPS through the strut of the previously placed stents of hepatic vein (HV), inferior vena cava (IVC) or TIPS in a single tertiary care hospital. Six of the patients were diagnosed with Budd–Chiari syndrome (BCS) and one with alcohol-induced chronic liver disease (CLD). Kaplan–Meier test was used to calculate 18- and 60-month primary patency rate of TIPS stent.


TIPS through the strut of a previously placed stent was technically successful in all the patients (100%). The TIPS was direct intrahepatic portosystemic shunt (DIPS) in 5/7 cases, due to occluded HV. Mean portosystemic pressure gradient (PPG) reduced from 24 mmHg ± 5.9 (range, pre-TIPS 15–31 mmHg) to 8.57 mmHg ± 4.4 (range, post-TIPS, 3–14 mmHg). One patient required three sessions of TIPS revisions. Another patient needed TIPS revision after 5 years of TIPS creation. All the patients showed improvement in clinical symptoms and in mean Child–Turcotte–Pugh (CTP) score and modified end-stage liver disease (MELD) score during mean follow-up period 40.57 month ± 34.9 (range 3–100 month). Primary patency rates of TIPS stent measured with Kaplan–Meier estimate at 18- and 60-month follow-up were 80% (95% CI, 37–97%) and 40% (95% CI, 10–97%), respectively.


TIPS through the strut of a previously placed stent is technically feasible with good long-term primary patency and clinical outcome.


Primary patency rate Budd–Chiari syndrome Direct intrahepatic portosystemic shunt Portosystemic pressure gradient Strutplasty 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

This is a retrospective study. For this type of study formal consent is not required.


  1. 1.
    Mancuso A. An update on management of Budd–Chiari syndrome. Ann Hepatol. 2014;13(3):323–6.PubMedGoogle Scholar
  2. 2.
    Surendrababu NR, Keshava SN, Eapen CE, Zachariah UG. Transjugular intrahepatic portocaval shunt placed through the strut of an inferior vena cava stent in a patient with Budd–Chiari syndrome: a technical modification. Br J Radiol. 2010;83(985):e22–4.CrossRefGoogle Scholar
  3. 3.
    Keshava SN, Kota GK, Mammen T, Jeyamani R, Moses V, Govil S, Kurian G, Chandy G. Direct intrahepatic cavo-portal shunts in Budd–Chiari syndrome: role of simultaneous fluoroscopy and trans-abdominal ultrasonography. Indian J Gastroenterol. 2006;25(5):248–50.PubMedGoogle Scholar
  4. 4.
    Lefèvre T, Louvard Y, Morice MC, Loubeyre C, Piéchaud JF, Dumas P. Stenting of bifurcation lesions: a rational approach. J Interv Cardiol. 2001;14(6):573–85.CrossRefGoogle Scholar
  5. 5.
    Joseph R, Keshava SN, Narayanam RS, John GT. Placement of a catheter through the struts of a previously placed stent for maintenance hemodialysis: a case report. Semin Dial. 2008;21(6):575–7.CrossRefGoogle Scholar
  6. 6.
    Tsauo J, Yu Y, Luo X, Wang Z, Liu L, Li X. Direct intrahepatic portocaval shunt creation via the inter-strut space of the inferior vena cava stent. Clin Radiol. 2014;69(9):896–9.CrossRefGoogle Scholar
  7. 7.
    Livingstone RS, Keshava SN. Technical note: reduction of radiation dose using ultrasound guidance during transjugular intrahepatic portosystemic shunt procedure. Indian J Radiol Imaging. 2011;21(1):13–4.CrossRefGoogle Scholar
  8. 8.
    He FL, Wang L, Yue ZD, Zhao HW, Liu FQ. Parallel transjugular intrahepatic portosystemic shunt for controlling portal hypertension complications in cirrhotic patients. World J Gastroenterol. 2014;20(33):11835–9.CrossRefGoogle Scholar
  9. 9.
    Gandini R, Konda D, Simonetti G. Transjugular intrahepatic portosystemic shunt patency and clinical outcome in patients with Budd–Chiari syndrome: covered versus uncovered stents. Radiology. 2006;241(1):298–305.CrossRefGoogle Scholar
  10. 10.
    Hernández-Guerra M, Turnes J, Rubinstein P, Olliff S, Elias E, Bosch J, et al. PTFE-covered stents improve TIPS patency in Budd–Chiari syndrome. Hepatology. 2004;40(5):1197–202.CrossRefGoogle Scholar
  11. 11.
    Weber CN, Nadolski GJ, White SB, Clark TW, Mondschein JI, Stavropoulos SW, et al. Long-term patency and clinical analysis of expanded polytetrafluoroethylene—covered transjugular intrahepatic portosystemic shunt stent grafts. J Vasc Interv Radiol. 2015;26(9):1257–65.CrossRefGoogle Scholar
  12. 12.
    Geeroms B, Laleman W, Laenen A, Heye S, Verslype C, van der Merwe S, et al. Expanded polytetrafluoroethylene-covered stent-grafts for transjugular intrahepatic portosystemic shunts in cirrhotic patients: Long term patency and clinical outcome results. Euro Radiol. 2017;27(5):1795–803.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018

Authors and Affiliations

  1. 1.Department of RadiologyChristian Medical CollegeVelloreIndia
  2. 2.Department of HepatologyChristian Medical CollegeVelloreIndia

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