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Purpose <p>The VIATORR Controlled Expansion (VCX) stent-graft was developed to allow more precise control of shunt diameter during transjugular intrahepatic portosystemic shunt (TIPS) creation. However, real-world data on its actual in vivo expansion behavior and short-term clinical implications remain limited. This study aimed to provide fluoroscopic quantitative assessment of early in vivo expansion of VCX stent-grafts and to assess its association with short-term overt hepatic encephalopathy (OHE).</p> Methods <p>This single-center retrospective cohort included consecutive patients with cirrhosis who underwent TIPS using either a legacy 8-mm VIATORR TIPS stent-graft (VTS) or a VCX stent-graft. In the VCX group, stents were initially dilated to 8&#xa0;mm and further dilated to 10&#xa0;mm only when post-procedural portal pressure gradient (PPG) remained &gt; 12 mmHg or decreased by &lt; 50% from baseline. Propensity score matching (PSM) was performed to compare short-term clinical outcomes between the VCX and VTS groups. The primary imaging outcome was early in vivo expansion of the VCX controlled mid-segment, assessed by fluoroscopic diameter measurements at implantation and 3-month follow-up. The main clinical safety outcome was new-onset OHE within 6 months after TIPS.</p> Results <p>A total of 177 patients were included (108 VTS and 69 VCX). Among VCX patients with paired imaging follow-up, the mid-segment diameter increased from 8.0&#xa0;mm at implantation to a mean of 8.65&#xa0;mm at 3 months (range 8.2–9.1&#xa0;mm; <i>p</i> &lt; 0.001). Mean post-TIPS PPG increased from 7.7 mmHg immediately after TIPS to 11.6 mmHg at 3 months (<i>p</i> &lt; 0.001), with no significant correlation between diameter change and PPG change. After PSM, 132 patients were analyzed. The cumulative 6-month incidence of OHE was numerically higher in the VCX group but did not reach statistical significance compared with VTS (HR 11.74, 95% CI 0.73–4.16; log-rank <i>p</i> = 0.204).</p> Conclusions <p>VCX stent-grafts exhibit measurable early self-expansion after implantation, indicating that the controlled-expansion segment may not remain fixed at the intended 8-mm diameter during early follow-up. While the incidence of OHE did not differ significantly between the VCX group and the VTS group after PSM, the observed expansion underscores the dynamic nature of post-TIPS stent behavior and supports imaging-based follow-up of shunt configuration and hemodynamic status.</p> Graphical abstract <p></p>

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Fluoroscopic quantification of early in vivo expansion of VIATORR controlled expansion stent-grafts after TIPS: hemodynamic and clinical implications

  • 期刊论文

  • 发表日期：

    2026年6月30日

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  • Zizhen Ye,
  • Ruoting Men,
  • Yi Shen,
  • Ziqi Chen,
  • Li Yang,
  • Xuefeng Luo,
  • Xiaoze Wang

摘要

Purpose

The VIATORR Controlled Expansion (VCX) stent-graft was developed to allow more precise control of shunt diameter during transjugular intrahepatic portosystemic shunt (TIPS) creation. However, real-world data on its actual in vivo expansion behavior and short-term clinical implications remain limited. This study aimed to provide fluoroscopic quantitative assessment of early in vivo expansion of VCX stent-grafts and to assess its association with short-term overt hepatic encephalopathy (OHE).

Methods

This single-center retrospective cohort included consecutive patients with cirrhosis who underwent TIPS using either a legacy 8-mm VIATORR TIPS stent-graft (VTS) or a VCX stent-graft. In the VCX group, stents were initially dilated to 8 mm and further dilated to 10 mm only when post-procedural portal pressure gradient (PPG) remained > 12 mmHg or decreased by < 50% from baseline. Propensity score matching (PSM) was performed to compare short-term clinical outcomes between the VCX and VTS groups. The primary imaging outcome was early in vivo expansion of the VCX controlled mid-segment, assessed by fluoroscopic diameter measurements at implantation and 3-month follow-up. The main clinical safety outcome was new-onset OHE within 6 months after TIPS.

Results

A total of 177 patients were included (108 VTS and 69 VCX). Among VCX patients with paired imaging follow-up, the mid-segment diameter increased from 8.0 mm at implantation to a mean of 8.65 mm at 3 months (range 8.2–9.1 mm; p < 0.001). Mean post-TIPS PPG increased from 7.7 mmHg immediately after TIPS to 11.6 mmHg at 3 months (p < 0.001), with no significant correlation between diameter change and PPG change. After PSM, 132 patients were analyzed. The cumulative 6-month incidence of OHE was numerically higher in the VCX group but did not reach statistical significance compared with VTS (HR 11.74, 95% CI 0.73–4.16; log-rank p = 0.204).

Conclusions

VCX stent-grafts exhibit measurable early self-expansion after implantation, indicating that the controlled-expansion segment may not remain fixed at the intended 8-mm diameter during early follow-up. While the incidence of OHE did not differ significantly between the VCX group and the VTS group after PSM, the observed expansion underscores the dynamic nature of post-TIPS stent behavior and supports imaging-based follow-up of shunt configuration and hemodynamic status.

Graphical abstract