Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 6, 2021; 9(7): 1532-1542
Published online Mar 6, 2021. doi: 10.12998/wjcc.v9.i7.1532
Effects of transjugular intrahepatic portosystemic shunt using the Viatorr stent on hepatic reserve function in patients with cirrhosis
Xin Yao, Hao Zhou, Shan Huang, Shan-Hong Tang, Jian-Ping Qin
Xin Yao, Jian-Ping Qin, Department of Gastroenterology, General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
Hao Zhou, Department of Gastroenterology, Fengjie County People's Hospital, Chongqing 404600, China
Shan Huang, Department of Digestive Medicine, General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
Shan-Hong Tang, Department of Digestion, General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
Author contributions: Yao X performed the operation and wrote the paper; Zhou H performed the operation and collected the data; Tang SH collected and analyzed the data; Huang S performed the operation and analyzed the data; Qin JP participated in and guided the operation and finalized the manuscript.
Institutional review board statement: This study was approved by the Hospital Ethics Committee.
Informed consent statement: The patients and their families were fully informed and provided written consent for surgery.
Conflict-of-interest statement: The authors declare no competing interests.
Data sharing statement: The study protocol, statistical analysis plan, and de-identified participant data can be made available upon request for non-commercial purposes and after approval of a study proposal through a signed data access agreement. Proposals should be directed to
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Jian-Ping Qin, MD, Doctor, Department of Gastroenterology, General Hospital of Western Theater Command, No. 273 Rongdu Road, Chengdu 610083, Sichuan Province, China.
Received: July 28, 2020
Peer-review started: July 28, 2020
First decision: November 23, 2020
Revised: December 7, 2020
Accepted: December 23, 2020
Article in press: December 23, 2020
Published online: March 6, 2021
Research background

As transjugular intrahepatic portosystemic shunt (TIPS) creation alters the hemodynamic status of the portal system, whether reduced portal blood supply affects the synthetic reserve function of the liver has been the focus of clinical attention.

Research motivation

Early clinical studies were based on the Fluency stents in establishing a shunt in the portal vein; stents should be placed in the portal vein so that sufficient length remains for the stent to shunt blood from the portal trunk, and affect portal vein branch blood supply. The Viatorr stent can be used to establish a TIPS shunt channel, where the bare stent region is established in a branch of the portal vein, to ensure smooth blood flow in the portal vein and avoid excess blood that has not passed directly through the liver entering the systemic circulation. Since the Viatorr stent entered the Chinese market in 2015, it has not yet been widely used in clinical practice. Further, unlike other countries, the main cause of liver cirrhosis in China is viral hepatitis. Therefore, use of the Viatorr stent to establish a TIPS channel in patients with liver cirrhosis with differing etiologies is of great clinical interest.

Research objectives

The purpose of this study was to investigate factors affecting changes in liver reserve function after TIPS Viatorr stent implantation, and to find ways to reduce the occurrence of liver failure and improve long-term survival rates.

Research methods

Clinical data from 200 patients with cirrhotic portal hypertension who received TIPS treatment from March 2016 to March 2020 were analyzed retrospectively. The patients were divided into three groups (A-C), according to their disease etiology, with post-hepatitis, autoimmune, and alcoholic cirrhosis, respectively. Preoperative and postoperative liver and renal function and coagulation data, Child-Pugh class, and model for end-stage liver disease (MELD) scores were collected. Statistical analyses were performed using the t-test or chi-square test. The incidence of hepatic encephalopathy and patient survival were calculated using the Kaplan-Meier method.

Research results

The surgical success rate was 100%, with mean portal pressure gradient (mmHg) decreasing from 25.5 ± 5.22 to 10.04 ± 2.76 (t = 45.80; P < 0.001). After 24 mo, the cumulative incidence of hepatic encephalopathy in group A was significantly lower than that in group B/C, while the cumulative survival rate was significantly higher in group A than in group B/C (P < 0.0.5 for both). The Child-Pugh score for group A was 6.96 ± 1.21, which was significantly better than those of groups B (7.42 ± 0.99; t = -2.44; P = 0.016) and C (7.52 ± 1.12; t = -2.67; P = 0.009). Further, the MELD score for group A (9.62 ± 2.19) was significantly better than those for groups B (10.64 ± 1.90; t = -2.92; P = 0.004) and C (10.82 ± 2.01; t = -3.29; P = 0.001).

Research conclusions

Insertion of a Viatorr stent with an internal diameter of 8 mm has no significant effects on liver reserve function.

Research perspectives

Changes of liver reserve function in the medium and long term may be related to the etiology and treatment of portal hypertension.