Long-term patency of the transjugular intrahepatic portosystemic shunt for portal and superior mesenteric vein thrombosis

This retrospective study evaluated the long-term patency of transjugular intrahepatic portosystemic shunt (TIPS) placement and identified predictors of shunt dysfunction in patients with portal and superior mesenteric vein thrombosis (PSVT). From January 2018 to January 2024, patients with symptomatic PSVT who underwent TIPS were enrolled. Clinical variables, imaging features, adverse events, and clinical outcomes were recorded. The cumulative rate of TIPS patency rates were calculated using the Kaplan-Meier method, with subgroup comparisons performed by the log-rank test. Independent predictors of shunt dysfunction were identified via Cox regression analysis. Forty-nine patients (mean age 47.8 ± 12.5 years; 79.6% male) were successfully treated with TIPS. Among them, 69.4% had cirrhosis and 49.0% had hepatitis B virus infection, with cirrhosis-related portal hypertension being the most common etiology of thrombosis. The 6-, 12-, and 24-month primary patency rates were 70.8% (95% CI: 59.0–85.0%), 66.4% (95% CI: 54.3–81.3%), and 56.5% (95% CI: 43.7–73.1%), respectively. Multivariate analysis identified sufficient inflow (patency of the splenic vein or an inflow vein diameter > 8 mm) and the use of covered stents in the main portal vein as independent predictors of TIPS patency. TIPS can be safely performed in patients with PSVT. Adequate inflow and the use of covered stents in the main portal vein are important factors for long-term TIPS patency.