- Department of Interventional Radiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Medical Imaging; National Clinical Research Center for Interventional Medicine, Shanghai 200032, P. R. China;
ZHANG Wen,
Email: zhang.wen2@zs-hospital.sh.cn
Transjugular intrahepatic portosystemic shunt (TIPS) has become a standard therapy for complications of portal hypertension. The key to maximizing the therapeutic efficacy of TIPS lies in balancing the reduction of portal hypertension-related complications (such as rebleeding and ascites) against the risk of complications from excessive shunting (such as hepatic encephalopathy and liver function deterioration). Given the significant heterogeneity among patients, including the etiology of cirrhosis, hepatic reserve function, and comorbidities, traditional “one-size-fits-all” shunting strategy has proven insufficient. Therefore, the concept of individualized planning for intrahepatic portosystemic shunts has emerged. This strategy aims to achieve personalized and precise shunting through careful patient selection, optimized hemodynamic target setting, controlled shunt diameter, and integrated adjuvant therapies.
Copyright ? the editorial department of CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY of West China Medical Publisher. All rights reserved
| 1. | Gracia-Sancho J, Marrone G, Fernández-Iglesias A. Hepatic microcirculation and mechanisms of portal hypertension. Nat Rev Gastroenterol Hepatol, 2019, 16(4): 221-234. |
| 2. | Bosch J, Groszmann RJ, Shah VH. Evolution in the understanding of the pathophysiological basis of portal hypertension: how changes in paradigm are leading to successful new treatments. J Hepatol, 2015, 62(1 Suppl): S121-S130. doi: 10.1016/j.jhep.2015.01.003. |
| 3. | Riggio O, Nardelli S, Moscucci F, et al. Hepatic encephalopathy after transjugular intrahepatic portosystemic shunt. Clin Liver Dis, 2012, 16(1): 133-146. |
| 4. | Sturm L, Schultheiss M, St?hr F, et al. Freiburg index of post-TIPS survival (FIPS) identifies patients at risk of further decompensation and ACLF after TIPS. J Hepatol, 2025, 83(2): 348-357. |
| 5. | 馬婧嶔, 羅劍鈞, 顏志平. 門靜脈高壓介入性精準分流. 介入放射學雜志, 2024, 33(10): 1045-1048. |
| 6. | Magaz M, Baiges A, Hernández-Gea V. Precision medicine in variceal bleeding: are we there yet?. J Hepatol, 2020, 72(4): 774-784. |
| 7. | Walter A, Rudler M, Olivas P, et al. Combination of model for end-stage liver disease and lactate predicts death in patients treated with salvage transjugular intrahepatic portosystemic shunt for refractory variceal bleeding. Hepatology, 2021, 74(4): 2085-2101. |
| 8. | García-Pagán JC, Caca K, Bureau C, et al. Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med, 2010, 362(25): 2370-2379. |
| 9. | Nicoar?-Farc?u O, Han G, Rudler M, et al. Effects of early placement of transjugular portosystemic shunts in patients with high-risk acute variceal bleeding: a meta-analysis of individual patient data. Gastroenterology, 2021, 160(1): 193-205. |
| 10. | Lv Y, Yang Z, Liu L, et al. Early TIPS with covered stents versus standard treatment for acute variceal bleeding in patients with advanced cirrhosis: a randomised controlled trial. Lancet Gastroenterol Hepatol, 2019, 4(8): 587-598. |
| 11. | Cervoni JP, Weil D, Desmarets M, et al. Pre-emptive TIPS for gastric variceal bleeding in patients with cirrhosis (GAVAPROSEC): an open-label randomised clinical trial. Lancet Gastroenterol Hepatol, 2025, 10(8): 726-733. |
| 12. | Bureau C, Thabut D, Oberti F, et al. Transjugular intrahepatic portosystemic shunts with covered stents increase transplant-free survival of patients with cirrhosis and recurrent ascites. Gastroenterology, 2017, 152(1): 157-163. |
| 13. | Nobel YR, Boike JR, Mazumder NR, et al. Predictors of long-term clinical outcomes after TIPS: an ALTA group study. Hepatology, 2025, 81(4): 1244-1255. |
| 14. | Bettinger D, Sturm L, Pfaff L, et al. Refining prediction of survival after TIPS with the novel Freiburg index of post-TIPS survival. J Hepatol, 2021, 74(6): 1362-1372. |
| 15. | Bommena S, Mahmud N, Boike JR, et al. The impact of right atrial pressure on outcomes in patients undergoing TIPS, an ALTA group study. Hepatology, 2023, 77(6): 2041-2051. |
| 16. | Berres ML, Asmacher S, Lehmann J, et al. CXCL9 is a prognostic marker in patients with liver cirrhosis receiving transjugular intrahepatic portosystemic shunt. J Hepatol, 2015, 62(2): 332-339. |
| 17. | Liu J, Ma J, Yang C, et al. Sarcopenia in patients with cirrhosis after transjugular intrahepatic portosystemic shunt placement. Radiology, 2022, 303(3): 711-719. |
| 18. | 中國醫師協會介入醫師分會. 中國門靜脈高壓經頸靜脈肝內門體分流術臨床實踐指南(2019年版). 臨床肝膽病雜, 2019, 35(12): 2694-2699. |
| 19. | Billey C, Billet S, Robic MA, et al. A prospective study identifying predictive factors of cardiac decompensation after transjugular intrahepatic portosystemic shunt: the Toulouse algorithm. Hepatology, 2019, 70(6): 1928-1941. |
| 20. | Schneider H, Berliner D, Stockhoff L, et al. Diastolic dysfunction is associated with cardiac decompensation after transjugular intrahepatic portosystemic shunt in patients with liver cirrhosis. United European Gastroenterol J, 2023, 11(9): 837-851. |
| 21. | Meucci MC, Hoogerduijn Strating MM, Butcher SC, et al. Left atrial dysfunction is an independent predictor of mortality in patients with cirrhosis treated by transjugular intrahepatic portosystemic shunt. Hepatol Commun, 2022, 6(11): 3163-3174. |
| 22. | Mauz JB, Rieland H, Berliner D, et al. High prevalence and clinical relevance of intrapulmonary vascular dilatations in patients undergoing TIPS implantation. Clin Gastroenterol Hepatol, 2024, 22(9): 1867-1877. |
| 23. | Nardelli S, Gioia S, Pasquale C, et al. Cognitive impairment predicts the occurrence of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt. Am J Gastroenterol, 2016, 111(4): 523-528. |
| 24. | Chen X, Huang M, Yu X, et al. Hepatic-associated vascular morphological assessment to predict overt hepatic encephalopathy before TIPS: a multicenter study. Hepatol Int, 2024, 18(4): 1238-1248. |
| 25. | Lv Y, Wang Q, Luo B, et al. Identifying the optimal measurement timing and hemodynamic targets of portal pressure gradient after TIPS in patients with cirrhosis and variceal bleeding. J Hepatol, 2025, 82(2): 245-257. |
| 26. | Ma L, Ma J, Zhang W, et al. Predictive power of portal pressure gradient remeasured shortly after transjugular intrahepatic portosystemic shunt. Hepatol Int, 2023, 17(2): 417-426. |
| 27. | Riedel C, Hoffmann M, Ismahil M, et al. Four-dimensional flow MRI-based computational fluid dynamics simulation for noninvasive portosystemic pressure gradient assessment in patients with cirrhosis and transjugular intrahepatic portosystemic shunt. Radiology, 2024, 313(1): e232989. doi: 10.1148/radiol.232989. |
| 28. | R?ssle M, Siegerstetter V, Olschewski M, et al. How much reduction in portal pressure is necessary to prevent variceal rebleeding? A longitudinal study in 225 patients with transjugular intrahepatic portosystemic shunts. Am J Gastroenterol, 2001, 96(12): 3379-3383. |
| 29. | Roccarina D, Saltini D, Adotti V, et al. End-procedural adherence to recommended hemodynamic targets does not improve the outcome of elective TIPS in patients with cirrhosis. Hepatology, 2025, 82(5): 1155-1171. |
| 30. | Wang X, Luo X, Yang L. Achieving an effective pressure reduction after TIPS: The need for a new target. J Hepatol, 2021, 75(1): 246-248. |
| 31. | Xia Y, Tie J, Wang G, et al. Optimal threshold of portal pressure gradient for patients with ascites after covered TIPS: a multicentre cohort study. Hepatol Int, 2025, 19(1): 199-211. |
| 32. | Kabelitz MA, Hartl L, Schaub G, et al. Identification of optimal portal pressure decrease to control ascites while minimizing HE after TIPS: a multicenter study. Hepatology, 2025, 82(5): 1172-1186. |
| 33. | Xia Y, Tie J, Wang G, et al. Individualized portal pressure gradient threshold based on liver function categories in preventing rebleeding after TIPS. Hepatol Int, 2023, 17(4): 967-978. |
| 34. | Ma L, Liu Y, Yan Z, et al. Comparing the predictive ability of portoatrial and portocaval gradient after transjugular intrahepatic portosystemic shunt creation for variceal rebleeding. J Gastroenterol, 2023, 58(5): 494-502. |
| 35. | Yan H, Xiang Z, Zhao C, et al. 6-mm shunt transjugular intrahepatic portosystemic shunt in patients with severe liver atrophy and variceal bleeding. Eur Radiol, 2024, 34(7): 4697-4707. |
| 36. | Zhang W, Zhang M, Xiao J, et al. Efficacy of 6-mm and 8-mm transjugular intrahepatic portosystemic shunt for variceal bleeding: a randomized controlled trial. Clin Gastroenterol Hepatol, 2025: S1542-S3565. doi: 10.1016/j.cgh.2025.06.023. |
| 37. | Dell T, Menne M, Wagenpfeil J, et al. How controlled is the expansion of VIATORR CX?. Cardiovasc Intervent Radiol, 2023, 46(5): 658-663. |
| 38. | Yin K, Wang X, Zheng T. Computational hemodynamic analysis for optimal stent position in the transjugular intrahepatic portosystemic shunt procedure. J Biomech, 2022, 143: 111303. |
| 39. | Chen L, Xiao T, Chen W, et al. Outcomes of transjugular intrahepatic portosystemic shunt through the left branch vs. the right branch of the portal vein in advanced cirrhosis: a randomized trial. Liver Int, 2009, 29(7): 1101-1109. |
| 40. | Zhou Y, Ma J, Liu Y, et al. Comparison of the impact of shunting the left versus right portal vein branch during TIPS on the postoperative overt hepatic encephalopathy: a randomized trial. Hepatol Int, 2025 Sep 18. doi: 10.1007/s12072-025-10908-1. |
| 41. | Gao W, Yin C, Zhou C, et al. Hemodynamic investigations on the portal hypertension and treatment of transjugular intrahepatic portosystemic shunt (TIPS) based on CFD simulation. J Biomech, 2025, 181: 112516. doi: 10.1016/j.jbiomech.2025.112516. |
| 42. | Ishikawa T, Sasaki R, Nishimura T, et al. Splenic non-infarction volume determines a clinically significant hepatic venous pressure gradient response to partial splenic embolization in patients with cirrhosis and hypersplenism. J Gastroenterol, 2021, 56(4): 382-394. |
| 43. | Wan YM, Li YH, Xu ZY, et al. Comparison of TIPS alone and combined with partial splenic embolization (PSE) for the management of variceal bleeding. Eur Radiol, 2019, 29(9): 5032-5041. |
| 44. | Li YH, Wu JF, Wu HM, et al. The effect of transjugular intrahepatic portosystemic shunt plus partial splenic embolization for the treatment of patients with recurrent variceal bleeding. Acad Radiol, 2020, 27(3): 323-331. |
| 45. | Liu J, Yao W, Bai Y, et al. Optimal timing for TIPS and PSE combination treatment in patients with cirrhosis-related variceal bleeding and hypersplenism. Acad Radiol, 2025, 32(3): 1534-1546. |
| 46. | Tiede A, Stockhoff L, Rieland H, et al. No value of non-selective beta-blockers after TIPS-insertion. Aliment Pharmacol Ther, 2024, 60(8): 1021-1032. |
| 47. | European Association for the Study of the Liver. EASL clinical practice guidelines on TIPS. J Hepatol, 2025, 83(1): 177-210. |
| 48. | Xia Y, Tie J, Wang G, et al. Small transjugular intrahepatic portosystemic shunt plus variceal embolization for gastric varices: a multicenter cohort study. Clin Gastroenterol Hepatol, 2025, 23(6): 965-977. |
| 49. | Lv Y, Chen H, Luo B, et al. Concurrent large spontaneous portosystemic shunt embolization for the prevention of overt hepatic encephalopathy after TIPS: a randomized controlled trial. Hepatology, 2022, 76(3): 676-688. |
| 50. | Lee EW, Eghtesad B, Garcia-Tsao G, et al. AASLD Practice Guidance on the use of TIPS, variceal embolization, and retrograde transvenous obliteration in the management of variceal hemorrhage. Hepatology, 2024, 79(1): 224-250. |
| 51. | Bureau C, Thabut D, Jezequel C, et al. The use of rifaximin in the prevention of overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunt : a randomized controlled trial. Ann Intern Med, 2021, 174(5): 633-640. |
| 52. | Lv Y, Bai W, Li K, et al. Anticoagulation and transjugular intrahepatic portosystemic shunt for the management of portal vein thrombosis in cirrhosis: a prospective observational study. Am J Gastroenterol, 2021, 116(7): 1447-1464. |
| 53. | Kabelitz MA, Gairing SJ, Tiede A, et al. Impact of frailty on the prognosis of patients with liver cirrhosis undergoing insertion of a TIPS. Aliment Pharmacol Ther, 2025 Aug 1. doi: 10.1111/apt.70315. |
| 54. | Xiong Z, Wang X, Yan Y, et al. A new computational fluid dynamics based noninvasive assessment of portacaval pressure gradient. J Biomech, 2024, 167: 112086. doi: 10.1016/j.jbiomech.2024.112086. |
| 55. | Gao W, Yin C, Zhou C, et al. Hemodynamic investigations on the portal hypertension and treatment of transjugular intrahepatic portosystemic shunt (TIPS) based on CFD simulation. J Biomech, 2025, 181: 112516. doi: 10.1016/j.jbiomech.2025.112516. |
| 56. | Dantas Machado AC, Ramos SF, Gauglitz JM, et al. Portosystemic shunt placement reveals blood signatures for the development of hepatic encephalopathy through mass spectrometry. Nat Commun, 2023, 14(1): 5303. doi: 10.1038/s41467-023-40741-9. |
| 57. | Li M, Li K, Tang S, et al. Restoration of the gut microbiota is associated with a decreased risk of hepatic encephalopathy after TIPS. JHEP Rep, 2022, 4(5): 100448. doi: 10.1016/j.jhepr.2022.100448. |
| 58. | Cheng S, Hu G, Jin Z, et al. Prediction of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt based on CT radiomic features of visceral adipose tissue. Acad Radiol, 2024, 31(5): 1849-1861. |
| 59. | Asciak L, Kyeremeh J, Luo X, et al. Digital twin assisted surgery, concept, opportunities, and challenges. NPJ Digit Med, 2025, 8(1): 32. doi: 10.1038/s41746-024-01413-0. |
- 1. Gracia-Sancho J, Marrone G, Fernández-Iglesias A. Hepatic microcirculation and mechanisms of portal hypertension. Nat Rev Gastroenterol Hepatol, 2019, 16(4): 221-234.
- 2. Bosch J, Groszmann RJ, Shah VH. Evolution in the understanding of the pathophysiological basis of portal hypertension: how changes in paradigm are leading to successful new treatments. J Hepatol, 2015, 62(1 Suppl): S121-S130. doi: 10.1016/j.jhep.2015.01.003.
- 3. Riggio O, Nardelli S, Moscucci F, et al. Hepatic encephalopathy after transjugular intrahepatic portosystemic shunt. Clin Liver Dis, 2012, 16(1): 133-146.
- 4. Sturm L, Schultheiss M, St?hr F, et al. Freiburg index of post-TIPS survival (FIPS) identifies patients at risk of further decompensation and ACLF after TIPS. J Hepatol, 2025, 83(2): 348-357.
- 5. 馬婧嶔, 羅劍鈞, 顏志平. 門靜脈高壓介入性精準分流. 介入放射學雜志, 2024, 33(10): 1045-1048.
- 6. Magaz M, Baiges A, Hernández-Gea V. Precision medicine in variceal bleeding: are we there yet?. J Hepatol, 2020, 72(4): 774-784.
- 7. Walter A, Rudler M, Olivas P, et al. Combination of model for end-stage liver disease and lactate predicts death in patients treated with salvage transjugular intrahepatic portosystemic shunt for refractory variceal bleeding. Hepatology, 2021, 74(4): 2085-2101.
- 8. García-Pagán JC, Caca K, Bureau C, et al. Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med, 2010, 362(25): 2370-2379.
- 9. Nicoar?-Farc?u O, Han G, Rudler M, et al. Effects of early placement of transjugular portosystemic shunts in patients with high-risk acute variceal bleeding: a meta-analysis of individual patient data. Gastroenterology, 2021, 160(1): 193-205.
- 10. Lv Y, Yang Z, Liu L, et al. Early TIPS with covered stents versus standard treatment for acute variceal bleeding in patients with advanced cirrhosis: a randomised controlled trial. Lancet Gastroenterol Hepatol, 2019, 4(8): 587-598.
- 11. Cervoni JP, Weil D, Desmarets M, et al. Pre-emptive TIPS for gastric variceal bleeding in patients with cirrhosis (GAVAPROSEC): an open-label randomised clinical trial. Lancet Gastroenterol Hepatol, 2025, 10(8): 726-733.
- 12. Bureau C, Thabut D, Oberti F, et al. Transjugular intrahepatic portosystemic shunts with covered stents increase transplant-free survival of patients with cirrhosis and recurrent ascites. Gastroenterology, 2017, 152(1): 157-163.
- 13. Nobel YR, Boike JR, Mazumder NR, et al. Predictors of long-term clinical outcomes after TIPS: an ALTA group study. Hepatology, 2025, 81(4): 1244-1255.
- 14. Bettinger D, Sturm L, Pfaff L, et al. Refining prediction of survival after TIPS with the novel Freiburg index of post-TIPS survival. J Hepatol, 2021, 74(6): 1362-1372.
- 15. Bommena S, Mahmud N, Boike JR, et al. The impact of right atrial pressure on outcomes in patients undergoing TIPS, an ALTA group study. Hepatology, 2023, 77(6): 2041-2051.
- 16. Berres ML, Asmacher S, Lehmann J, et al. CXCL9 is a prognostic marker in patients with liver cirrhosis receiving transjugular intrahepatic portosystemic shunt. J Hepatol, 2015, 62(2): 332-339.
- 17. Liu J, Ma J, Yang C, et al. Sarcopenia in patients with cirrhosis after transjugular intrahepatic portosystemic shunt placement. Radiology, 2022, 303(3): 711-719.
- 18. 中國醫師協會介入醫師分會. 中國門靜脈高壓經頸靜脈肝內門體分流術臨床實踐指南(2019年版). 臨床肝膽病雜, 2019, 35(12): 2694-2699.
- 19. Billey C, Billet S, Robic MA, et al. A prospective study identifying predictive factors of cardiac decompensation after transjugular intrahepatic portosystemic shunt: the Toulouse algorithm. Hepatology, 2019, 70(6): 1928-1941.
- 20. Schneider H, Berliner D, Stockhoff L, et al. Diastolic dysfunction is associated with cardiac decompensation after transjugular intrahepatic portosystemic shunt in patients with liver cirrhosis. United European Gastroenterol J, 2023, 11(9): 837-851.
- 21. Meucci MC, Hoogerduijn Strating MM, Butcher SC, et al. Left atrial dysfunction is an independent predictor of mortality in patients with cirrhosis treated by transjugular intrahepatic portosystemic shunt. Hepatol Commun, 2022, 6(11): 3163-3174.
- 22. Mauz JB, Rieland H, Berliner D, et al. High prevalence and clinical relevance of intrapulmonary vascular dilatations in patients undergoing TIPS implantation. Clin Gastroenterol Hepatol, 2024, 22(9): 1867-1877.
- 23. Nardelli S, Gioia S, Pasquale C, et al. Cognitive impairment predicts the occurrence of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt. Am J Gastroenterol, 2016, 111(4): 523-528.
- 24. Chen X, Huang M, Yu X, et al. Hepatic-associated vascular morphological assessment to predict overt hepatic encephalopathy before TIPS: a multicenter study. Hepatol Int, 2024, 18(4): 1238-1248.
- 25. Lv Y, Wang Q, Luo B, et al. Identifying the optimal measurement timing and hemodynamic targets of portal pressure gradient after TIPS in patients with cirrhosis and variceal bleeding. J Hepatol, 2025, 82(2): 245-257.
- 26. Ma L, Ma J, Zhang W, et al. Predictive power of portal pressure gradient remeasured shortly after transjugular intrahepatic portosystemic shunt. Hepatol Int, 2023, 17(2): 417-426.
- 27. Riedel C, Hoffmann M, Ismahil M, et al. Four-dimensional flow MRI-based computational fluid dynamics simulation for noninvasive portosystemic pressure gradient assessment in patients with cirrhosis and transjugular intrahepatic portosystemic shunt. Radiology, 2024, 313(1): e232989. doi: 10.1148/radiol.232989.
- 28. R?ssle M, Siegerstetter V, Olschewski M, et al. How much reduction in portal pressure is necessary to prevent variceal rebleeding? A longitudinal study in 225 patients with transjugular intrahepatic portosystemic shunts. Am J Gastroenterol, 2001, 96(12): 3379-3383.
- 29. Roccarina D, Saltini D, Adotti V, et al. End-procedural adherence to recommended hemodynamic targets does not improve the outcome of elective TIPS in patients with cirrhosis. Hepatology, 2025, 82(5): 1155-1171.
- 30. Wang X, Luo X, Yang L. Achieving an effective pressure reduction after TIPS: The need for a new target. J Hepatol, 2021, 75(1): 246-248.
- 31. Xia Y, Tie J, Wang G, et al. Optimal threshold of portal pressure gradient for patients with ascites after covered TIPS: a multicentre cohort study. Hepatol Int, 2025, 19(1): 199-211.
- 32. Kabelitz MA, Hartl L, Schaub G, et al. Identification of optimal portal pressure decrease to control ascites while minimizing HE after TIPS: a multicenter study. Hepatology, 2025, 82(5): 1172-1186.
- 33. Xia Y, Tie J, Wang G, et al. Individualized portal pressure gradient threshold based on liver function categories in preventing rebleeding after TIPS. Hepatol Int, 2023, 17(4): 967-978.
- 34. Ma L, Liu Y, Yan Z, et al. Comparing the predictive ability of portoatrial and portocaval gradient after transjugular intrahepatic portosystemic shunt creation for variceal rebleeding. J Gastroenterol, 2023, 58(5): 494-502.
- 35. Yan H, Xiang Z, Zhao C, et al. 6-mm shunt transjugular intrahepatic portosystemic shunt in patients with severe liver atrophy and variceal bleeding. Eur Radiol, 2024, 34(7): 4697-4707.
- 36. Zhang W, Zhang M, Xiao J, et al. Efficacy of 6-mm and 8-mm transjugular intrahepatic portosystemic shunt for variceal bleeding: a randomized controlled trial. Clin Gastroenterol Hepatol, 2025: S1542-S3565. doi: 10.1016/j.cgh.2025.06.023.
- 37. Dell T, Menne M, Wagenpfeil J, et al. How controlled is the expansion of VIATORR CX?. Cardiovasc Intervent Radiol, 2023, 46(5): 658-663.
- 38. Yin K, Wang X, Zheng T. Computational hemodynamic analysis for optimal stent position in the transjugular intrahepatic portosystemic shunt procedure. J Biomech, 2022, 143: 111303.
- 39. Chen L, Xiao T, Chen W, et al. Outcomes of transjugular intrahepatic portosystemic shunt through the left branch vs. the right branch of the portal vein in advanced cirrhosis: a randomized trial. Liver Int, 2009, 29(7): 1101-1109.
- 40. Zhou Y, Ma J, Liu Y, et al. Comparison of the impact of shunting the left versus right portal vein branch during TIPS on the postoperative overt hepatic encephalopathy: a randomized trial. Hepatol Int, 2025 Sep 18. doi: 10.1007/s12072-025-10908-1.
- 41. Gao W, Yin C, Zhou C, et al. Hemodynamic investigations on the portal hypertension and treatment of transjugular intrahepatic portosystemic shunt (TIPS) based on CFD simulation. J Biomech, 2025, 181: 112516. doi: 10.1016/j.jbiomech.2025.112516.
- 42. Ishikawa T, Sasaki R, Nishimura T, et al. Splenic non-infarction volume determines a clinically significant hepatic venous pressure gradient response to partial splenic embolization in patients with cirrhosis and hypersplenism. J Gastroenterol, 2021, 56(4): 382-394.
- 43. Wan YM, Li YH, Xu ZY, et al. Comparison of TIPS alone and combined with partial splenic embolization (PSE) for the management of variceal bleeding. Eur Radiol, 2019, 29(9): 5032-5041.
- 44. Li YH, Wu JF, Wu HM, et al. The effect of transjugular intrahepatic portosystemic shunt plus partial splenic embolization for the treatment of patients with recurrent variceal bleeding. Acad Radiol, 2020, 27(3): 323-331.
- 45. Liu J, Yao W, Bai Y, et al. Optimal timing for TIPS and PSE combination treatment in patients with cirrhosis-related variceal bleeding and hypersplenism. Acad Radiol, 2025, 32(3): 1534-1546.
- 46. Tiede A, Stockhoff L, Rieland H, et al. No value of non-selective beta-blockers after TIPS-insertion. Aliment Pharmacol Ther, 2024, 60(8): 1021-1032.
- 47. European Association for the Study of the Liver. EASL clinical practice guidelines on TIPS. J Hepatol, 2025, 83(1): 177-210.
- 48. Xia Y, Tie J, Wang G, et al. Small transjugular intrahepatic portosystemic shunt plus variceal embolization for gastric varices: a multicenter cohort study. Clin Gastroenterol Hepatol, 2025, 23(6): 965-977.
- 49. Lv Y, Chen H, Luo B, et al. Concurrent large spontaneous portosystemic shunt embolization for the prevention of overt hepatic encephalopathy after TIPS: a randomized controlled trial. Hepatology, 2022, 76(3): 676-688.
- 50. Lee EW, Eghtesad B, Garcia-Tsao G, et al. AASLD Practice Guidance on the use of TIPS, variceal embolization, and retrograde transvenous obliteration in the management of variceal hemorrhage. Hepatology, 2024, 79(1): 224-250.
- 51. Bureau C, Thabut D, Jezequel C, et al. The use of rifaximin in the prevention of overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunt : a randomized controlled trial. Ann Intern Med, 2021, 174(5): 633-640.
- 52. Lv Y, Bai W, Li K, et al. Anticoagulation and transjugular intrahepatic portosystemic shunt for the management of portal vein thrombosis in cirrhosis: a prospective observational study. Am J Gastroenterol, 2021, 116(7): 1447-1464.
- 53. Kabelitz MA, Gairing SJ, Tiede A, et al. Impact of frailty on the prognosis of patients with liver cirrhosis undergoing insertion of a TIPS. Aliment Pharmacol Ther, 2025 Aug 1. doi: 10.1111/apt.70315.
- 54. Xiong Z, Wang X, Yan Y, et al. A new computational fluid dynamics based noninvasive assessment of portacaval pressure gradient. J Biomech, 2024, 167: 112086. doi: 10.1016/j.jbiomech.2024.112086.
- 55. Gao W, Yin C, Zhou C, et al. Hemodynamic investigations on the portal hypertension and treatment of transjugular intrahepatic portosystemic shunt (TIPS) based on CFD simulation. J Biomech, 2025, 181: 112516. doi: 10.1016/j.jbiomech.2025.112516.
- 56. Dantas Machado AC, Ramos SF, Gauglitz JM, et al. Portosystemic shunt placement reveals blood signatures for the development of hepatic encephalopathy through mass spectrometry. Nat Commun, 2023, 14(1): 5303. doi: 10.1038/s41467-023-40741-9.
- 57. Li M, Li K, Tang S, et al. Restoration of the gut microbiota is associated with a decreased risk of hepatic encephalopathy after TIPS. JHEP Rep, 2022, 4(5): 100448. doi: 10.1016/j.jhepr.2022.100448.
- 58. Cheng S, Hu G, Jin Z, et al. Prediction of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt based on CT radiomic features of visceral adipose tissue. Acad Radiol, 2024, 31(5): 1849-1861.
- 59. Asciak L, Kyeremeh J, Luo X, et al. Digital twin assisted surgery, concept, opportunities, and challenges. NPJ Digit Med, 2025, 8(1): 32. doi: 10.1038/s41746-024-01413-0.