title: TIPS geometry influences patency.
abstract: OBJECTIVE
  The purpose of this study was to evaluate potential causes of Transjugular intrahepatic portosystemic shunt (TIPS) dysfunction.
  
  
  METHODS
  We retrospectively evaluated 26 patients who required TIPS revision (group I) and 24 patients who did not require any further intervention (group II) within the first two years following TIPS implantation. The distance of the distal end of the stent to the hepatocaval junction was measured. Furthermore, the angle between the stent and the portal vein (inflow) and the angle between the stent and the hepatic vein (outflow) were measured. Furthermore, the following data were evaluated: pre- and postinterventional portal pressure gradients, maximal postinterventional flow and blood values [C-reactive protein (CRP), bilirubin, glutamic-oxaloacetic transaminase (GOT), glutamic-pyruvic transaminase (GPT)].
  
  
  RESULTS
  Compared with control subjects, patients who required TIPS revision showed a significantly longer distance from the distal end of the stent to the hepatocaval junction (I: 17.3 ± 10 mm, II: 6.7 ± 5.7 mm, p < 0.001). There was a statistically significant correlation between the above named distance and the time to revision (Pearson's correlation coefficient, r = 0.5, p = 0.01). In addition, patients with TIPS revision had a significantly larger angle of portalvenous inflow (alpha angle) than the control group (I: 100.5 ± 31.5°, II: 64.5 ± 31.6°, p < 0.001).
  
  
  CONCLUSIONS
  Our results show that the distance from the end of the stent to the hepatocaval junction and the angle of portalvenous inflow are technical factors that may influence the shunt's patency rate. Of these two, the distance to the hepatocaval junction can be influenced easily by the interventionalist.
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Duesseldorf, Medical Faculty, Duesseldorf.
authors.forename: J
authors.initials: J
authors.lastname: Klasen-Sansone
authors.affiliation: Department of Gastroenterology, Hepatology and Infectiology, University Duesseldorf, Medical Faculty, Duesseldorf.
authors.forename: J
authors.initials: J
authors.lastname: Bode
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Duesseldorf, Medical Faculty, Duesseldorf.
authors.forename: R S
authors.initials: RS
authors.lastname: Lanzman
authors.affiliation: Department of Gastroenterology, Hepatology and Infectiology, University Duesseldorf, Medical Faculty, Duesseldorf.
authors.forename: R
authors.initials: R
authors.lastname: Kubitz
authors.affiliation: Department of Gastroenterology, Hepatology and Infectiology, University Duesseldorf, Medical Faculty, Duesseldorf.
authors.forename: S
authors.initials: S
authors.lastname: Immig
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Duesseldorf, Medical Faculty, Duesseldorf.
authors.forename: P
authors.initials: P
authors.lastname: Heusch
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Duesseldorf, Medical Faculty, Duesseldorf.
authors.forename: G
authors.initials: G
authors.lastname: Antoch
authors.affiliation: Department of Gastroenterology, Hepatology and Infectiology, University Duesseldorf, Medical Faculty, Duesseldorf.
authors.forename: D
authors.initials: D
authors.lastname: Häussinger
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Duesseldorf, Medical Faculty, Duesseldorf.
authors.forename: D
authors.initials: D
authors.lastname: Blondin
mesh_terms: D001783:Blood Flow Velocity; D019544:Equipment Failure Analysis; D006085:Graft Survival / Q000502:physiology*; D006503:Hepatic Veins / Q000502:physiology*; D006801:Humans; D008102:Liver Circulation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology*