Do the stent blind insertion into the main portal vein (MPV) and stent diameter influence the surgical outcome of the transjugular intrahepatic portosystemic shunt (TIPS)?

• Published in: Computers in biology and medicine Vol. 164; p. 107306
• Main Authors: Jiang, Lingyu, Han, Hao, Yang, Jian, Fang, Runxin, Xin, Ying, Chen, Qiang, Yao, Jing, Li, Zhiyong
• Format: Journal Article
• Language: English
• Published: United States Elsevier Ltd 01.09.2023; Elsevier Limited
• Subjects: Accuracy; Blind insertion; Clinical outcomes; Computational fluid dynamics; Fluid dynamics; Hemodynamics; Hepatic encephalopathy; Hypertension; Implants; Insertion; Internal Medicine; Other; Photovoltaic cells; Portal hypertension; Portal vein; Pressure drop; Shunts; Simulation; Stent diameter; Stents; Surgery; Transjugular intrahepatic portosystemic shunt; Ultrasonic imaging; Veins; Veins & arteries; Velocity; Viscosity; United States > US; Stent diameter; Blind insertion; Computational fluid dynamics; Transjugular intrahepatic portosystemic shunt; Portal hypertension
• ISSN: 0010-4825; 1879-0534; 1879-0534
• DOI: 10.1016/j.compbiomed.2023.107306

Transjugular intrahepatic portosystemic shunt (TIPS) surgery is a clinical intervention to treat portal hypertension (PH) by deploying a covered stent to establish a shunt path for the portal vein (PV) system, and proper surgical strategy is of great importance to balance the shunt effect and the risk of complications. To understand the clinical strategies of the stent blind insertion and stent selection in clinic, this study investigated the effects of varying stent insertion positions and diameters on the PV hemodynamics and the shunt effect by computational fluid dynamics (CFD) analysis of five post-TIPS subjects. The results showed that the successful TIPS surgeries of the five PH subjects were confirmed by quantifying their pressure drops. The stent insertion positions at the main portal vein (MPV) slightly affected the clinically concerned hemodynamic indexes (i.e., MPV pressure, stent-outlet velocity) and the shunt index (SI). This indicated that the position of the stent going into the MPV may not need to be deliberately selected. Moreover, the covered stents with 6 mm and 8 mm diameters slightly influenced the hemodynamics as well, but the large-diameter stent better improved the shunt effect compared to the small-diameter one. Despite this, the 6 mm stent was suggested thanks to the higher risk of the hepatic encephalopathy (HE) observed in clinic, which indicated the excessive shunt of the 8 mm stent. The current work revealed the effects of different TIPS strategies on the surgical outcome, and could be useful for potential clinical practices. •MPV-TIPS surgery was evaluated by computational fluid analysis.•Stent insertion position and diameter weakly influenced the hemodynamic indexes.•Stent diameter had a stronger effect on the shunt effect than the insertion position.•The 6 mm stent was suggested compared to the 8 mm stent.•The current study provided a theoretical insight to understand the clinical practice.