{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T20:20:29Z","timestamp":1790367629696,"version":"4.1.0"},"reference-count":17,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background &amp; Aims<\/jats:title>\n                    <jats:p>Under\u2010dilated trans\u2010jugular intra\u2010hepatic porto\u2010systemic shunt (U\u2010TIPS, \u2264\u20097\u2009mm) effectively controls portal hypertension (PH) complications that placed the indication to TIPS while reducing the incidence of hepatic encephalopathy. However, TIPS efficacy in preventing additional PH\u2010complications is reported only for standard endoprosthesis dilation (\u2265\u20098\u2009mm, S\u2010TIPS). This study evaluated whether U\u2010TIPS provides protection comparable to S\u2010TIPS against PH\u2010complications beyond the initial indication, independent of achieving guideline\u2010defined hemodynamic targets.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients treated for refractory ascites (RA) or secondary prophylaxis of PH\u2010related bleeding (PHRB) were included. Adequate hemodynamic response (AHR) was defined as post\u2010TIPS PCPG &lt;\u200912\u2009mm Hg in RA, and\u2009&lt;\u200912\u2009mm Hg or reduction \u2265\u200950% in PHRB. Porto\u2010caval pressure gradient (PCPG) values outside these criteria were deemed an inadequate response (IHR). Post\u2010TIPS spontaneous bacterial peritonitis, acute renal injury hepatorenal syndrome\u2010related, hepatic hydrothorax, need for paracentesis, and bleeding, were assessed individually and as a composite endpoint over one year.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 358 patients, 257 (72%) received U\u2010TIPS and 101 (28%) S\u2010TIPS. The incidence of at least one post\u2010TIPS event was higher in S\u2010TIPS vs. U\u2010TIPS (14% vs. 6%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.022), with no significant difference between AHR and IHR groups (9% vs. 7%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.543). On multivariable analysis, S\u2010TIPS (OR 3.13, 95% CI 1.38, 7.21,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006), Child\u2010Pugh class B (OR 11.6, 95% CI 2.14, 217,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.021) and C (OR 14.4, 95% CI 1.17, 343,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.042), higher MELD score (OR 1.20, 95% CI 1.09, 1.32,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) were independently associated with post\u2010TIPS events.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>U\u2010TIPS provides non\u2010inferior protection against other PH\u2010complications irrespective of achieving hemodynamic efficacy targets.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/liv.70606","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T06:44:11Z","timestamp":1774593851000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Prevention of Portal Hypertension Complications Beyond Primary\n                    <scp>TIPS<\/scp>\n                    Indication Is Independent of Endoprosthesis Under\u2010Dilation"],"prefix":"10.1111","volume":"46","author":[{"given":"Davide","family":"Roccarina","sequence":"first","affiliation":[{"name":"Department of Experimental and Clinical Medicine University of Florence  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dario","family":"Saltini","sequence":"additional","affiliation":[{"name":"Severe Liver Diseases Departmental Unit (M.E.C.), AOU Policlinico of Modena, University of Modena and Reggio Emilia  Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Senzolo","sequence":"additional","affiliation":[{"name":"Unit of Vascular Liver Diseases and Treatment of Portal Hypertension, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University\u2010Hospital of Padua  Padua Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Nardelli","sequence":"additional","affiliation":[{"name":"Department of Translational and Precision Medicine Sapienza University of Rome  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Scami","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine University of Florence  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tommaso","family":"Zurli","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine University of Florence  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristian","family":"Caporali","sequence":"additional","affiliation":[{"name":"Interventional Radiology Unit, AOU Policlinico of Modena, University of Modena and Reggio Emilia  Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Rosi","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine University of Florence  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Adotti","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine University of Florence  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcello","family":"Bianchini","sequence":"additional","affiliation":[{"name":"Severe Liver Diseases Departmental Unit (M.E.C.), AOU Policlinico of Modena, University of Modena and Reggio Emilia  Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lara","family":"Biribin","sequence":"additional","affiliation":[{"name":"Unit of Vascular Liver Diseases and Treatment of Portal Hypertension, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University\u2010Hospital of Padua  Padua Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefania","family":"Gioia","sequence":"additional","affiliation":[{"name":"Department of Translational and Precision Medicine Sapienza University of Rome  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Aspite","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine University of Florence  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Ragozzino","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine University of Florence  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomas","family":"Guasconi","sequence":"additional","affiliation":[{"name":"Severe Liver Diseases Departmental Unit (M.E.C.), AOU Policlinico of Modena, University of Modena and Reggio Emilia  Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Casari","sequence":"additional","affiliation":[{"name":"Interventional Radiology Unit, AOU Policlinico of Modena, University of Modena and Reggio Emilia  Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Piscopo","sequence":"additional","affiliation":[{"name":"Severe Liver Diseases Departmental Unit (M.E.C.), AOU Policlinico of Modena, University of Modena and Reggio Emilia  Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Pindozzi","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine University of Florence  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Gitto","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine University of Florence  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio Luca","family":"Annese","sequence":"additional","affiliation":[{"name":"Department of Radiology, Interventional Radiology Unit, Careggi Hospital  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo","family":"Gabbani","sequence":"additional","affiliation":[{"name":"Department of Radiology, Interventional Radiology Unit, Careggi Hospital  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melania","family":"Gaggini","sequence":"additional","affiliation":[{"name":"Institute of Clinical Physiology, National Research Council  Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1554-1739","authenticated-orcid":false,"given":"Kymentie","family":"Ferdinande","sequence":"additional","affiliation":[{"name":"Unit of Vascular Liver Diseases and Treatment of Portal Hypertension, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University\u2010Hospital of Padua  Padua Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuele","family":"Casamassima","sequence":"additional","affiliation":[{"name":"Department of Radiology, Interventional Radiology Unit, Careggi Hospital  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3173-9767","authenticated-orcid":false,"given":"Manuela","family":"Merli","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Biotecnologiche Medico Chirurgiche, Sapienza University of Rome  Rome 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Shunts Versus Endoscopic Intervention With or Without Medical Treatment for Prevention of Rebleeding in People With Cirrhosis","volume":"10","author":"Simonetti R. G.","year":"2020","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2015.05.011"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.28318"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2016.09.016"}],"container-title":["Liver International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/liv.70606","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/liv.70606","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/liv.70606","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T12:16:37Z","timestamp":1783426597000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/liv.70606"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,26]]},"references-count":17,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1111\/liv.70606"],"URL":"https:\/\/doi.org\/10.1111\/liv.70606","archive":["Portico"],"relation":{},"ISSN":["1478-3223","1478-3231"],"issn-type":[{"value":"1478-3223","type":"print"},{"value":"1478-3231","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,26]]},"assertion":[{"value":"2025-08-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-06","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-26","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70606"}}