Transjugular Intrahepatic Portosystemic Shunt (TIPS) Check and Revision in a Freestanding Outpatient Facility: Safety and Efficacy

Aim This study aims to evaluate the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) check and revision procedures performed in a freestanding interventional radiology (IR) outpatient facility. Methodology A total of 40 patients (male 31:female 9, median age 60 years old) underwent a TIPS check and/or revision at a freestanding IR outpatient facility between 2009 and 2017. Procedures were performed using a mobile C-arm unit under intravenous (IV) moderate sedation, with the patient discharged home on the same day. The decision to perform a TIPS check was based on abnormal surveillance ultrasound findings or the recurrence of portal hypertension symptoms. TIPS were revised if the patient was found to have angiographic stenosis, elevated portosystemic gradients, or recurrent symptoms. TIPS were revised with balloon angioplasty and/or bare metal stent placement. Results Revision was attempted in 34 cases, and 6 were found to not require a revision. The average time to revision was 19 months (range 0.6-99 months). Of the 40 patients, 24 (60%) underwent a TIPS check and/or revision due to findings from surveillance ultrasound, while 16 (40%) underwent a check or revision due to a recurrence of symptoms. Of the 34 TIPS revisions, 28 (83%) involved angioplasty alone, 5 (15%) were stent-assisted, and 1 failed due to unsuccessful cannulation. The overall technical success rate for performing the revisions was 94% (32/34). The one-year patency rate was approximately 57%. The mean fluoroscopy time was 16.1 minutes (range: 3.7-52.5 minutes). Post-procedural recovery time was minimal, averaging one to two hours. No major complications were observed (0%, 0/40). One patient (2.5%, 1/40) experienced a minor complication (access site hematoma), and two patients were hospitalized within 30 days for reasons unrelated to the procedure. Conclusions TIPS revision can be performed successfully and safely in an outpatient facility.