Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Oct 27, 2023; 15(10): 2133-2141
Published online Oct 27, 2023. doi: 10.4240/wjgs.v15.i10.2133
Stent fracture after transjugular intrahepatic portosystemic shunt placement using the bare metal stent/stent-graft combination technique
Qi-Jia Liu, Xiao-Feng Cao, Yun Pei, Xuan Li, Guo-Xiang Dong, Chang-Ming Wang
Qi-Jia Liu, Yun Pei, Xuan Li, Guo-Xiang Dong, Chang-Ming Wang, Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing 100191, China
Xiao-Feng Cao, Department of Interventional Therapy, Yangquan First People’s Hospital, Yangquan 045000, Shanxi Province, China
Author contributions: Liu QJ and Wang CM conceptualized and designed the study; Liu QJ, Cao XF, and Pei Y collected data and carried out the initial analyses; Liu QJ drafted the initial manuscript; Li X, Dong GX, and Wang CM reviewed and revised the manuscript; Wang CM coordinated and supervised questionnaires collection, and critically reviewed the manuscript for important intellectual content; All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Institutional review board statement: The study was reviewed and approved for publication by our Institutional Reviewer.
Informed consent statement: As the study used anonymous and pre-existing data, the requirement for the informed consent from patients was waived.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: No additional data available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chang-Ming Wang, MD, Surgeon, Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, No. 49 North Garden Rd., Haidian District, Beijing 100191, China. wcmwy@163.com
Received: May 18, 2023
Peer-review started: May 18, 2023
First decision: August 10, 2023
Revised: August 22, 2023
Accepted: September 12, 2023
Article in press: September 12, 2023
Published online: October 27, 2023
Processing time: 162 Days and 7.9 Hours
Abstract
BACKGROUND

A transjugular intrahepatic portosystemic shunt (TIPS) is widely placed to treat portal hypertension. Because the Viatorr® stent (W. L. Gore and Associates, Flagstaff, AZ, United States) is not available in all hospitals in China, the bare metal stent (BMS)/stent-graft combination technique is still popular for TIPS construction. Stent fracture is a complication after TIPS placement using this technique, with limited available literature focusing on it.

AIM

To assess the incidence of stent fracture after TIPS placement using the BMS/ stent-graft combination technique and to identify the risk factors for stent fracture. We proposed technique modifications to improve the clinical results of TIPS placement with the BMS/stent-graft combination technique.

METHODS

We retrospectively analyzed the computed tomography (CT) data of all patients with portal hypertension who underwent the TIPS procedure between June 2011 and December 2021 in a single center. Patients implanted with the BMS/stent graft and had follow-up imaging data available were included. We identified patients with stent fracture and analyzed their characteristics. Multivariable logistic regression was applied to identify the potential predictors of stent fracture.

RESULTS

Of the 68 included patients, stent fracture occurred in seven (10.3%) patients. Based on CT images, the stent fractures were categorized into three types. Our study consisted of four (57.1%) type I fractures, one (14.3%) type II fracture, one (14.3%) type IIIa fracture, and one (14.3%) type IIIb fracture. After adjusting for covariates, multivariable logistic regression revealed that the risk factors for stent fracture were the implantation of a greater number of stents [adjusted odds ratio (aOR) = 22.2, 95% confidence interval (CI): 1.2-415.4, P = 0.038] and a larger proximal sagittal stent bending angle (aOR = 1.1, 95%CI: 1.0-1.3, P = 0.020).

CONCLUSION

Stent fracture occurred in approximately 10% of patients with portal hypertension who underwent TIPS with the BMS/stent-graft combination technique. The number of implanted stents and stent bending angle at the inferior vena cava end were predictors of stent fracture, which suggests that the incidence of stent fracture could potentially be reduced by procedural modifications.

Keywords: Portal hypertension, Transjugular intrahepatic portosystemic shunt, Stent fracture, Bare metal stent/stent-graft combination, Risk factor, Fracture types

Core Tip: The bare metal stent (BMS)/stent-graft combination technique for transjugular intrahepatic portosystemic shunt construction has an incidence of stent fractures of around 10%, which all occurred at the junction of BMS and the proximal end of the stent-graft. Fractures may be associated with the number of stents implanted and stent excessive bending. Hence, we recommend a greater overlap of the stent-graft with the BMS at the inferior vena cava (IVC) end of the shunt, and the selection of a position closer to the opening of the hepatic vein into the IVC as the starting puncture site to establish a shunt.