Safety and Efficacy of Overdilation of 10mm Viatorr Transjugular Intrahepatic Portosystemic Shunt Stents Using 12mm Balloons

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Objective The aim of this study was to evaluate overdilation of 10–mm standard and 8–10mm controlled-expansion Viatorr stents to 12mm during transjugular intrahepatic portosystemic shunt (TIPS) placement when insufficient reduction (<50%) in portosystemic gradient (PSG) is achieved with standard 10mm dilation. Materials and Methods It is a single-institution, institutional review board-approved, retrospective review of TIPS (2013–2022) to identify patients in the overdilation group (12mm dilation of a 10-mm stent) and a control group (10mm dilation of a 10-mm stent) matched for age, indication, stent type, Model for End-Stage Liver Disease (MELD) score, pre-TIPS PSG, and variceal embolization. Stent diameter, technical success, clinical outcomes, and adverse events were assessed for both groups. Results TIPS was created for the overdilation group ( n =35, 57±11 years, 69% male; MELD: 14±5) and control group ( n =35, 57±11 years, 83% male; MELD: 14±5). Overdilation to 12mm adequately reduced PSG by more than 50% (55 vs. 65% in the control group, p =0.11). The stent diameter was larger in the overdilation group on cross-sectional imaging (9.8±0.2 vs. 9.5±0.4mm, p <0.001), with an estimated 57% higher volume flow rate ( p =0.002). Patients were followed for a median of 11.3 months (range: 0.03–75) and 15.6 months (range: 0.03–106) in the overdilation and control groups, respectively. There was an equivalent rate of ascites resolution (56 vs. 63%, p =0.68) and rebleeding (13 vs. 17%, p =0.82) in the overdilation and control groups, with a similar risk of new-onset hepatic encephalopathy (41 vs. 33%, p =0.51) and TIPS occlusion (11 vs. 9%, p =0.69). Overdilation did not result in any instance of stent fracture. Conclusion Overdilation of 10-mm Viatorr stents with 12mm balloons may provide benefit by potentially reducing PSG further for patients initially having inadequate PSG reduction with short-term safety.

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