Impact of Proximal Stent Placement Site on Postoperative Outcomes After TIPS: Hepatic Vein Versus Inferior Vena Cava.

RATIONALE AND OBJECTIVES: This study aimed to assess whether proximal covered stent placement in the hepatic vein (HV) versus the inferior vena cava (IVC) in cirrhotic patients undergoing transjugular intrahepatic portosystemic shunt (TIPS) is associated with postoperative complications. METHODS: In this retrospective study, 309 patients undergoing TIPS were analyzed, including 257 patients with proximal stent placement in the IVC and 52 in the HV. Postoperative complications were compared between groups through univariable and multivariable logistic regression analyses. Propensity score matching (PSM) was applied to balance baseline characteristics. RESULTS: In the entire cohort, the overall postoperative complication rate was 52.1%. The HV group demonstrated a significantly lower incidence of overt hepatic encephalopathy (OHE) compared with the IVC group (13.5% vs 34.6%, P = 0.004). However, stent position was not associated with postoperative ascites or rebleeding. Etiology, pre-TIPS ascites, and Child-Pugh class B were independent predictors of postoperative ascites, and TIPS dysfunction was associated with a higher risk of rebleeding. After PSM, conditional logistic regression analysis showed that HV placement remained independently associated with lower odds of OHE (odds ratio [OR] = 0.33, 95% confidence interval [CI]: 0.13-0.84; P = 0.020), with no significant between-group differences in ascites or rebleeding. Results from sensitivity and inverse probability of treatment weighting (IPTW)-based analyses were consistent with the primary findings. CONCLUSION: In cirrhotic patients undergoing TIPS, proximal stent placement in the HV is associated with a lower risk of postoperative OHE, while no significant association was observed with postoperative ascites or rebleeding.