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Keywords:

  • assisted patency;
  • pathogenesis;
  • primary shunt insufficiency;
  • shunt occlusion

Abstract: Objectives: Parallel shunts (PS) are used in the management of transjugular intrahepatic portosystemic stent-shunt (TIPS) insufficiency, a major limitation of the technique. This study describes the natural history of PS, and uses them as a model to assess the role of host factors in the development of primary shunt insufficiency.

Methods: Out of 338 patients with TIPS, 40 (11.8%) patients required insertion of a PS. Baseline and follow-up data of these patients were collected. Regular shunt surveillance involved biannual clinic visits and transjugular portography.

Results: The non-PS group (group 1; n=298) and the PS group (group 2; n=40) had similar baseline demographic and disease characteristics. Index shunts of both groups and the PS produced a significant portal pressure gradient drop (P<0.001), which was less in the index shunts of Group 2 (P<0.02 for both). PS had similar cumulative shunt patency rates to those of the index shunts of Group 1, and both were greater than those of index shunts in Group 2 (P<0.001 for both). The intervention rate (number of interventions/number of check portograms × 100) was similar for PS and the index shunts of Group 1 (38.7% and 43% respectively), but was significantly higher in the index shunts of Group 2 (85.6%; P<0.01 for both). In Group 1 and Group 2, 144 patients (48.3%) and 21 patients (52.5%) died during follow-up after a median period of 23.4 and 8.9 months respectively.

Conclusions: These findings do not support the hypothesis that shunt insufficiency is related to host factors.