{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T13:16:52Z","timestamp":1771334212229,"version":"3.50.1"},"reference-count":37,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T00:00:00Z","timestamp":1766102400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T00:00:00Z","timestamp":1766102400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100003042","name":"Else Kr\u00f6ner-Fresenius-Stiftung","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003042","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>A transjugular intrahepatic portosystemic shunt (TIPS) can effectively overcome portal hypertension, but is prevented by contraindications in a considerable proportion of patients. In this study, we investigated the option of a constrained TIPS (cTIPS) with reduced diameter for high\u2010risk patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Elective cTIPS were placed in 60 high\u2010risk patients at Hannover Medical School (10\/2020\u201304\/2023). In the cTIPS procedure, a 6\u2009mm stent(\u2212graft) was inserted first into the intrahepatic tract to constrain the TIPS endoprosthesis. Procedural data, complications and 12\u2009months follow\u2010up were recorded. A control cohort of patients with standard TIPS (sTIPS) was generated using propensity score matching, resulting in 40 patients per group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Indications for cTIPS were cardiac impairment, poor liver function and\/or history of hepatic encephalopathy (HE) in 22, 17 and 8 patients, respectively. cTIPS was technically successful in all patients. Portosystemic gradient (PSG) was successfully lowered in both groups (sTIPS: median 60% reduction and cTIPS: median 50% reduction from an initial PSG of 15\u2009mmHg in both groups,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006), while post\u2010TIPS PSG remained higher in the cTIPS group compared to the sTIPS group (cTIPS: median 7\u2009mmHg vs. sTIPS: median 6\u2009mmHg;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.042). TIPS dysfunction and revision were significantly more frequent in the cTIPS cohort than in the sTIPS cohort (sTIPS: 1 vs. cTIPS: 9;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.014 and sTIPS: 7 vs. cTIPS: 13;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.036). Control of portal hypertensive symptoms (no paracentesis, no bleeding) was similar in both groups (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.267), but overt HE was less frequent in the cTIPS group than in the sTIPS group (sTIPS: 14 vs. cTIPS: 4;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.042).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The constrained TIPS may offer a more careful step\u2010up approach for selected high\u2010risk TIPS patients. The technical procedure appears to be safe and feasible, however the risk for thrombosis and therefore needed revisions is increased. Larger study cohorts are needed to further explore promising results.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/liv.70436","type":"journal-article","created":{"date-parts":[[2025,12,20]],"date-time":"2025-12-20T05:14:49Z","timestamp":1766207689000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Expandable Constrained Transjugular Intrahepatic Portosystemic Shunt: An Individualised Approach for High\u2010Risk Patients?"],"prefix":"10.1111","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4906-3948","authenticated-orcid":false,"given":"Hannah","family":"Rieland","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology Hannover Medical School  Hannover Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timo C.","family":"Meine","sequence":"additional","affiliation":[{"name":"Institute for Diagnostic and Interventional Radiology Hannover Medical School  Hannover Germany"},{"name":"PRACTIS Clinician Scientist Program, Dean's Office for Academic Career Development Hannover Medical School  Hannover Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5936-8307","authenticated-orcid":false,"given":"Anja","family":"Tiede","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology Hannover Medical School  Hannover Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jim B.","family":"Mauz","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology Hannover Medical School  Hannover Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2906-0480","authenticated-orcid":false,"given":"Heiner","family":"Wedemeyer","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology Hannover Medical School  Hannover Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0135-7082","authenticated-orcid":false,"given":"Jan B.","family":"Hinrichs","sequence":"additional","affiliation":[{"name":"Institute for Diagnostic and Interventional Radiology Hannover Medical School  Hannover Germany"},{"name":"Department of Radiology St. Bernward Hospital  Hildesheim Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank K.","family":"Wacker","sequence":"additional","affiliation":[{"name":"Institute for Diagnostic and Interventional Radiology Hannover Medical School  Hannover Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin","family":"Maasoumy","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology Hannover Medical School  Hannover Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,12,19]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1155\/2014\/762096"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvir.2015.09.018"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2018.03.024"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2020.09.018"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2017.05.006"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2018.01.029"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2006-941447"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1051-0443(07)61516-4"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvir.2009.03.042"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvir.2009.10.019"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2005-925558"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0035-1549376"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1148\/rg.241035028"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11604-024-01618-z"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-023-10346-3"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0043-1764285"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.09.2968"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00270-015-1249-2"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvir.2019.01.031"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.14309\/ctg.0000000000000376"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhepr.2021.100264"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1186\/s42155-025-00557-8"},{"issue":"2","key":"e_1_2_12_24_1","first-page":"215","article-title":"Older Age Is Associated With Increased Early Mortality After Transjugular Intrahepatic Portosystemic Shunt","volume":"15","author":"Saad N.","year":"2016","journal-title":"Annals of Hepatology"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1259\/bjr.20170409"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.17.18222"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0235199"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep4.1829"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1055\/a-0873-4658"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.20559"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00261-020-02589-1"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00270-021-03054-2"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2021.12.022"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1038\/bmt.2012.244"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diii.2020.11.004"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvir.2014.10.021"},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.21037\/cdt.2017.10.03"},{"key":"e_1_2_12_38_1","doi-asserted-by":"publisher","DOI":"10.1177\/1076029616689593"}],"container-title":["Liver International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/liv.70436","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/liv.70436","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/liv.70436","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T12:27:26Z","timestamp":1771331246000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/liv.70436"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,19]]},"references-count":37,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1111\/liv.70436"],"URL":"https:\/\/doi.org\/10.1111\/liv.70436","archive":["Portico"],"relation":{},"ISSN":["1478-3223","1478-3231"],"issn-type":[{"value":"1478-3223","type":"print"},{"value":"1478-3231","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,19]]},"assertion":[{"value":"2025-04-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-31","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-19","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70436"}}