Viatorr versus WallFlex stents in TIPS: A single-centre South African study

Abstract

Background: Transjugular intrahepatic portosystemic shunt (TIPS) procedures are vital in managing complications of portal hypertension. The Viatorr stent is the standard for TIPS, but availability constraints often necessitate the use of alternatives such as WallFlex. Comparative data on their outcomes are limited.
Objectives: This study aimed to compare 12-month clinical outcomes of WallFlex and Viatorr stents in patients undergoing TIPS creation at a single tertiary centre.
Method: A retrospective review of 83 adult patients who underwent TIPS placement between June 2018 and November 2023 was performed. Forty patients received WallFlex stents (June 2018 – October 2020) and 43 received Viatorr stents (November 2020 – November 2023). Baseline clinical parameters, procedural data and outcomes were analysed. The primary outcome was the need for TIPS revision within 12 months; secondary outcomes included post-TIPS complications, hepatic encephalopathy, liver transplantation and mortality.
Results: Baseline characteristics were comparable. There were no significant differences between WallFlex and Viatorr stents for TIPS revision, complications, hepatic encephalopathy, transplantation or mortality. At 12 months, TIPS revision rates were 28% for WallFlex and 35% for Viatorr (p = 0.79). Complications occurred in 80% and 60% of patients, respectively; hepatic encephalopathy in 20% versus 21%; transplantation in 38% versus 26%; and mortality in 38% versus 21% (p > 0.05).
Conclusion: WallFlex and Viatorr stents demonstrated comparable 12-month outcomes in TIPS procedures. WallFlex represents a clinically acceptable alternative in resource-constrained settings.
Contribution: This study provides the first local comparative data on WallFlex and Viatorr stents for TIPS in South Africa, highlighting WallFlex as a viable alternative where Viatorr availability is limited.