Effectiveness of controlled-expansion transjugular intrahepatic portosystemic shunt (CX-TIPS) in an interdisciplinary setting at a large tertiary center.

Introduction: The use of controlled-expansion transjugular intrahepatic portosystemic shunt (CX-TIPS) effectively controls portal hypertension (PH)-related complications while reducing risks related to fully expanded stents. We evaluated the effectiveness of CX-TIPS in a large Viennese patient cohort.

Method: We assessed the number of patients evaluated for CX-TIPS placement by interdisciplinary discussion at the Medical University of Vienna and included all patients from the prospective AUTIPS registry undergoing CX-TIPS placement between June 2018 - December 2024. After clinical and laboratory characterization at baseline, patients were followed up for clinical events.

Results: Overall, 200 patients underwent interdisciplinary evaluation for CX-TIPS. In 62.5% CX-TIPS was recommended and 82.4% of these patients underwent CX-TIPS placement. Among 103 patients with CX-TIPS placement between June 2018 - December 2024 (median age 57 years, 67.0% male, median MELD 11), the primary indication for CX-TIPS implantation was ascites (65.0%). The median portal pressure gradient decreased from 18 mm Hg to 8 mm Hg after CX-TIPS. Underdilated CX-TIPS placement was performed in 13.6% (n = 14) of patients and portal vein recanalization (PVR-TIPS) was performed in 4 patients. During a median follow-up time of 13.5 months, 30.1% of patients experienced hepatic encephalopathy and 5.8% cardiac decompensation. Kaplan-Meier survival analyses revealed 1‑year and 3‑year transplant-free survival rates of 78.0% and 74.7%, respectively.

Conclusion: Implementation of interdisciplinary case discussions and the use of CX-TIPS enable personalized medicine in patients with cirrhosis. Underdilation of CX-TIPS should be considered in patients at high risk for complications.