Background and Aims: Transjugular intrahepatic portosystemic shunt (TIPS) is a wellestablished approach for the management of variceal bleeding, refractory ascites, hepatic hydrothorax, and preoperative treatment of portal hypertension prior to major abdominal surgery in patients with compensated cirrhosis, and so on. This study aimed to investigate the safety and long-term efficacy of TIPS implantation using Viatorr TIPS stent-grafts. Material and Methods: A cohort of 59 patients undergoing TIPS placement using Viatorr TIPS stent-grafts were included, and the periprocedural events, and long-term mortality, shunt dysfunction, variceal rebleeding and incidence of hepatic encephalopathy (HE) were analyzed. Results: The technical success rate was 100%. The median portosystemic pressure gradient was reduced from 21 mmHg (interquatile range: 19-25) to 13 mmHg (interquatile range: 10-16) before and after TIPS, leading to a hemodynamic success rate of 72.9%. The cumulative rate of overall mortality was 34.2% at five years, and direct bilirubin (hazard ratio [HR] = 1.336, 95% confidence interval [CI]: 1.050-1.700, P = 0.018) and post-TIPS right atrial pressure (HR = 1.238, 95% CI: 1.015-1.510, P = 0.035) were independent predictors for mortality. The cumulative rates of shunt dysfunction and variceal rebleeding were 11.0% and 28.3% at five years, respectively, and portal venous pressure gradient (HR = 2.572, 95% CI: 1.094-6.047, P = 0.030) was the only independent predictor for shunt dysfunction. The cumulative four-year HE-free rate was 48.6%. No severe adverse event was noted during TIPS procedures. Conclusion: Elective TIPS implantation using Viatorr TIPS stent-grafts is generally safe, and the long-term efficacy is favorable for the treatment of cirrhotic patients with recurrent variceal bleeding or refractory ascites.

AIM: To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) in combination with partial splenic arterial embolization (PSE) for cirrhotic patients with recurrent variceal bleeding and hypersplenism. METHODS: Institutional review board approval was obtained; all patients provided informed consent. From January 2010 to December 2014, a total of 141 cirrhotic patients received TIPS alone(group A, n=114) and simultaneous combined TIPS and PSE(group B, n=27) for recurrent variceal bleeding and hypersplenism secondary to portal hypertension. The TIPS was created by using covered stents. All patients underwent embolotherapy via the jugular vein after TIPS implantation. Patients in group B (n=27) received simultaneous PSE after creation of TIPS. Biochemical tests, coagulation function, complete blood cell (CBC) counts, frequencies of recurrent variceal bleeding and hepatic encephalopathy (HE), and survival were evaluated. Model for end stage liver diseases (MELD) scores were calculated. RESULTS: TIPS creation was successful in all patients. After the treatments, patients in group B had better hepatic synthetic function, increased levels of white blood cells (WBC), platelets (PLT), and hemoglobin(HGB), lower frequency of HE, lower overall and cirrhosis-related mortality than patients in group A (P0.05). Multivariate analysis showed that MELD scores, HE, and group were independent factors for overall and liver-related mortality at month 24 (P<0.05). No severe complications were observed in the two groups. CONCLUSIONS: Simultaneous combined TIPS and PSE regimen improves hematologic parameters, prevents deterioration of liver function and coagulation funct