ST 2025

Welcome to SIR Today, your guide to the events, programming and faculty that make the SIR annual meeting a memorable meeting for the interventional radiology community each year. Watch for more preview content to be published in the coming weeks, as well as daily previews and recaps of scientific sessions, award presentations, and during the week of the meeting in March. For the latest details on presenters, times and locations, refer to the SIR 2025 website and the annual meeting mobile app.

Long-term outcomes of TEPS for non-TIPS candidates

Abstract No. 152: Long-term Safety and Efficacy of Transvenous Extrahepatic Portosystemic Shunts

A new study shows that transvenous extrahepatic portosystemic shunt (TEPS) creation may be a feasible alternative for patients who are unsuitable for transjugular intrahepatic portosystemic shunt (TIPS) creation.

“We aimed to evaluate the technical feasibility and short- and long-term safety and outcomes of TEPS creation with intravascular ultrasound (IVUS) guidance in patients who are unsuitable for traditional TIPS and direct intrahepatic portocaval shunt (DIPS),” said Aakash N. Gupta, MD, author of Long-term Safety and Efficacy of Transvenous Extrahepatic Portosystemic Shunts, one of the SIR 2025 Featured Abstracts.

Dr. Gupta and his team were motivated by the need for effective techniques for portal and mesenteric decompression in complex patients, particularly those who are not candidates for conventional TIPS, DIPS, and, more recently, PVR-TIPs. According to Dr. Gupta, most of these patients also have life-threatening gastrointestinal hemorrhages. “Alternative approaches, such as TEPS, may be necessary in extensive portomesenteric occlusion, altered hepatic anatomy or obstructed intrahepatic path,” Dr. Gupta said.

Researchers retrospectively analyzed data from 22 patients who underwent 23 TEPS creations for indications like variceal bleeding, refractory ascites and pre-operative decompression. According to Dr. Gupta, the TEPS creation included portocaval, splenorenal, and superior and inferior mesocaval shunts.

The study found that TEPS was technically successful in all cases and demonstrated good, long-term patency, effectively reducing pressure and managing the initial conditions.

“The high patency rates, which may be accentuated by the extrahepatic location away from any mixing with bile, indicate that this technique could serve as a viable alternative for managing sequelae of portal hypertension in patients who are not suitable for TIPS or DIPS,” said Dr. Gupta.

However, complete bypassing of portal flow into the liver may have negative consequences, Dr. Gupta said, such as encephalopathy as well as portopulmonary hepatopulmonary syndrome.

“It's important to note that our study demonstrates high periprocedural safety with zero instances of intra-abdominal hemorrhage, stent migration and hollow viscus injury,” he said. However, delayed outcomes of hepatopulmonary and portopulmonary syndrome occurred in two patients, likely related to vasoactive substances in the mesenteric outflow bypassing hepatic clearance, he said.

“We are discussing other possible techniques to decompress portal and splanchnic venous hypertension that could preserve or even increase trophic hepatopetal flow,” Dr. Gupta said. “Also, forward-firing IVUS may become available and may further broaden the potential for navigation and creation of unconventional shunts.”

Dr. Gupta will present his findings at SIR 2025 in Nashville on Monday, March 31, at 3 p.m. during the Portal Hypertension 2 session.