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

doi:10.4240/wjgs.v15.i10.2133

Stent fracture after transjugular intrahepatic portosystemic shunt placement using the bare metal stent/stent-graft combination technique

World J Gastrointest Surg. 2023 Oct 27;15(10):2133-2141. doi: 10.4240/wjgs.v15.i10.2133.

Authors

Qi-Jia Liu¹, Xiao-Feng Cao², Yun Pei¹, Xuan Li¹, Guo-Xiang Dong¹, Chang-Ming Wang³

Affiliations

¹ Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing 100191, China.
² Department of Interventional Therapy, Yangquan First People's Hospital, Yangquan 045000, Shanxi Province, China.
³ Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing 100191, China. wcmwy@163.com.

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