Transjugular intrahepatic portosystemic shunt in a private Mexican medical setting: Indications and hemodynamic and technical outcomes

Abstract

Introduction: Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure for portal hypertension complications. However, regional geographical differences pose a particular challenge. This study analyzed the indications and the hemodynamic and technical outcomes of TIPS in patients with liver cirrhosis in a private medical setting in northern Mexico. Material and Methods: Three interventional radiologists conducted this cross-sectional study in two private Mexican hospitals between March 2004 and March 2024. Age, gender, etiology of cirrhosis, indications for TIPS, Child–Pugh score, and model for end-stage liver disease (MELD) were recorded electronically. The hemodynamic and technical outcomes of the TIPS were also recorded. Results: In total, 85 TIPS procedures were performed, 76.5% (n = 65) were performed in the last 10 years. The indications for TIPS were mainly secondary prevention of recurrent variceal bleeding in 47 (55.3%) patients, followed by refractory ascites in 35 (41.1%). Hemodynamic success was achieved in 73.7% from 2004 to 2013 and increased to 95.2% from 2014 to 2024, with a mean final portosystemic pressure gradient (PSPG) of 9 mmHg. Technical success, completing the shunt on the first attempt, was 100% over two decades. The most common etiology of cirrhosis was metabolic-associated fatty liver disease (MAFLD) (n = 29 patients, 34.1%). Conclusion: The main indication for TIPS in our study was secondary prevention of recurrent variceal bleeding, and hemodynamic and technical success was high. This study is the first in Mexico to analyze the indications and hemodynamic and technical outcomes of patients undergoing TIPS.