title: Selection of a TIPS stent for management of portal hypertension in liver cirrhosis: an evidence-based review.
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.
authors.affiliation: Xing-Shun Qi, Ming Bai, Zhi-Ping Yang, Dai-Ming Fan, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China.
authors.forename: Xing-Shun
authors.initials: XS
authors.lastname: Qi
authors.affiliation: Xing-Shun Qi, Ming Bai, Zhi-Ping Yang, Dai-Ming Fan, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Bai
authors.affiliation: Xing-Shun Qi, Ming Bai, Zhi-Ping Yang, Dai-Ming Fan, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China.
authors.forename: Zhi-Ping
authors.initials: ZP
authors.lastname: Yang
authors.affiliation: Xing-Shun Qi, Ming Bai, Zhi-Ping Yang, Dai-Ming Fan, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China.
authors.forename: Dai-Ming
authors.initials: DM
authors.lastname: Fan
mesh_terms: D004867:Equipment Design; D019317:Evidence-Based Medicine; D006470:Hemorrhage / Q000503:physiopathology; D006501:Hepatic Encephalopathy; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*; D008103:Liver Cirrhosis / Q000150:complications* / Q000601:surgery*; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000295:instrumentation* / Q000379:methods*; D015607:Stents; D014648:Varicose Veins / Q000503:physiopathology
keywords: Hepatic encephalopathy; Liver cirrhosis; Portal hypertension; Shunt dysfunction; Transjugular intrahepatic portosystemic shunt; Variceal bleeding