Acute Transjugular Intrahepatic Portosystemic Shunt Migration Into Pulmonary Artery During Liver Transplantation

Abstract

Transjugular intrahepatic portosystemic shunt has become an accepted intervention to treat sequelae of end-stage liver disease such as refractory ascites and esophageal varices for patients awaiting liver transplantation. Technical difficulties in such patients at the time of transplantation are usually limited to malpositioning of the stent requiring modification of the usual vascular anastomoses. Migration of the stent intraoperatively has not been a reported complication in the literature. We report a case in which a patient with a previously placed transjugular intrahepatic portosystemic shunt underwent successful liver transplantation complicated by intraoperative migration of the stent into the left pulmonary artery. The stent was removed from the pulmonary artery postoperatively using interventional radiology techniques.

Strecker stent migration to the pulmonary artery: long-term result of a "wait-and-see attitude"

“…Most of the reported cases were due to transjugular intrahepatic portosystemic shunt [2,3,4,11]. Two cases were due to dislodgement from the left 768 Fig.…”

“…1 Superior vena cavography. Stent migration into the right pulmonary artery Retrieval from the heart, through a single 12-F jugular sheath [3,4,11] or a 10-F femoral sheath [5], has been successfully performed with a Wallstent stent [4, 5] and a Palmaz stent [3], respectively. Among the various retrieval techniques [13,14,15], the extraction technique using the angioplasty balloon [16] seems to be the best adapted.…”

“…With a Strecker stent, removal from an 11-F sheath is only possible if the device can be grasped at the proximal and distal ends with snares [11] and compressed to reduce its diameter. Percutaneous removal through a jugular [4, 6, 11] or a femoral sheath, surgical venous iliac incision [5] or relocation in the suprarenal inferior vena cava [8], or the iliac or femoral veins [3] are the successful techniques described in the literature.…”

“…Accidental migration of a venous endoprosthesis into the right cavities or the pulmonary artery has been described as a rare complication of venous stenting [1,2,3, 4, 5, 6, 7, 8]. We report the first case of a Strecker stent migration into the right pulmonary artery in a cancer patient, successfully managed with anticoagulant therapy and a ªwait-and-seeº attitude.…”

Liver transplantation with simultaneous removal of an intracardiac transjugular intrahepatic portosystemic shunt and a vena cava filter without the utilization of cardiopulmonary bypass

“…Transjugular intrahepatic portosystemic shunts (TIPSs) are widely used to manage the complications of portal venous hypertension, including gastroesophageal variceal bleeding, refractory ascites, and hepatic hydrothorax 1, 2. Complications of TIPSs include misplacement or migration of the stent to distant locations 3–5. Extraction of TIPSs has been described as a challenging maneuver during liver transplantation (LT) 6, 7.…”