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Selection of a TIPS stent for management of portal hypertension in liver cirrhosis: An evidence-based review
Authors:Xing-Shun Qi  Ming Bai  Zhi-Ping Yang  Dai-Ming Fan  Xijing Hospital of Digestive Diseases,Fourth Military Medical University  
Affiliation:Department of Gastroenterology,No. 463 Hospital of Chinese PLA;
Abstract:Nowadays, transjugular intrahepatic portosystemic shunt (TIPS) has become a mainstay treatment option for the management of portal hypertension-related complications in liver cirrhosis. Accumulated evidence has shown that its indications are being gradually expanded. Notwithstanding, less attention has been paid for the selection of an appropriate stent during a TIPS procedure. Herein, we attempt to review the current evidence regarding the diameter, type, brand, and position of TIPS stents. Several following recommendations may be considered in the clinical practice: (1) a 10-mm stent may be more effective than an 8-mm stent for the management of portal hypertension, and may be superior to a 12-mm stent for the improvement of survival and shunt patency; (2) covered stents are superior to bare stents for reducing the development of shunt dysfunction; (3) if available, Viatorr stent-grafts may be recommended due to a higher rate of shunt patency; and (4) the placement of a TIPS stent in the left portal vein branch may be more reasonable for decreasing the development of hepatic encephalopathy. However, given relatively low quality of evidence, prospective well-designed studies should be warranted to further confirm these recommendations.
Keywords:Transjugular intrahepatic portosystemic shunt   Portal hypertension   Liver cirrhosis   Variceal bleeding   Hepatic encephalopathy   Shunt dysfunction
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