Published online Jun 7, 2014. doi: 10.3748/wjg.v20.i21.6470
Revised: January 18, 2014
Accepted: February 17, 2014
Published online: June 7, 2014
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.
Core tip: This review suggests the following: first, a 10-mm stent may be more effective than an 8-mm or 12-mm stent for the management of portal hypertension in liver cirrhosis; second, Viatorr covered stents may be recommended for maintaining the shunt patency; finally, the placement of a transjugular intrahepatic portosystemic shunt stent in the left portal vein branch may be more reasonable for decreasing the development of hepatic encephalopathy.