Haemolysis and cholestasis following implantation of a transjugular intrahepatic portosystemic shunt

Cheng, Kam H.; Laméris, Johan S.; Man, Robert A. de; Pieterman, H.; Buuren, Henk R. van

doi:10.1097/00042737-199408000-00020

Cited by 6 publications

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“…Injury occurs as red blood cells collide with the unendothelialized bare wire mesh of the stent, particularly along the free hepatic and portal venous ends. [7][8][9][10]14 Hemolytic anemia related to other implanted devices is a known phenomenon, and traumatic red cell damage from high-flow shear stress induced by heart valve prostheses and aortic bypass grafts has been previously reported. 11 Flow models have shown that hemolysis by shear stress is found in flow velocities greater than 2,000 cm/s.…”

Section: Discussionmentioning

confidence: 99%

Hemolytic Anemia following Stent-Graft Transjugular Intrahepatic Portosystemic Shunt Creation

Kuei

Mikolajczyk

Niemeyer

2019

Semin intervent Radiol

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Transjugular intrahepatic portosystemic shunt (TIPS) creation is a minimally invasive technique aimed at managing the complications of portal hypertension. Initially performed in the setting of variceal bleeding, the role of TIPS has expanded to treatment of medically refractory ascites, portal hypertensive gastropathy, hepatic hydrothorax, Budd-Chiari syndrome, portal vein thrombus, and hepatorenal syndrome. Potential complications from TIPS are well documented, and include hepatic encephalopathy, hepatic failure, and TIPS dysfunction. Hemolytic anemia is a lesser known complication related to TIPS creation. In this article, a case of hemolytic anemia following TIPS creation using a Viatorr stent-graft in described.

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Section: Discussionmentioning

confidence: 99%

Hemolytic Anemia following Stent-Graft Transjugular Intrahepatic Portosystemic Shunt Creation

Kuei

Mikolajczyk

Niemeyer

2019

Semin intervent Radiol

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“…Two patients required a second implantation after stenosis or occlusion of the stent. 16,18 In one serum haptoglobin concentration was significantly lower in the patent TIPS group than in the control of the patients, the hemolysis had apparently started before the second implantation. Before placing the group (32 { 58 vs. 69 { 51 mg/dL; P õ .02).…”

Section: Fig 1 This Partially Nakedmentioning

confidence: 90%

“…Riggio et al reported three cases with hemolytic in hemoglobin concentration of ú4 g, 1 showed a decrease of 3 to 4 g, 2 had decrements of 2 to 3 g/dL, anemia, 17 and Cheng et al described one. 18 A few additional patients with post-TIPS hemolysis have been menand 2 exhibited no significant changes in hemogloblin concentration, all of the abnormalities subsided sponta-tioned in non-peer-reviewed, preliminary communications, but few clinical or laboratory data were presented. 19-21 neously within 3 to 4 months.…”

Section: Fig 1 This Partially Nakedmentioning

confidence: 99%

Hemolysis after transjugular intrahepatic portosystemic shunting: The naked stent syndrome

Conn¹

1996

Hepatology

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SEE ARTICLE ON PAGE 32. venous pressure and the severity of PSE after TIPS are inversely related. 12 In 1992, Sanyal et al reported a post-TIPS patient with Naked we came into the world, and naked we shall depart hemolytic anemia and progressive hepatic encephalopathy from it.(HE), which they attributed to the stent, 13 although the Aesop, Fables relationship between the encephalopathy and the hemolyTransjugular intrahepatic portosystemic shunts sis was not clear. The patient, a Korean man with post-(TIPS) is an exciting new technique for the treatment HCV cirrhosis, received a Wallstent implant (Schneider, of portal hypertension. In the 8 years since it was first Inc., Minneapolis, MN) following an episode of hemordescribed, 1 it has been reported to be almost magical rhage from esophageal varices. Over the next 10 days, in its control of portal hypertension 2,3 and bleeding var-the serum bilirubin level increased and the hemoglobin ices 4 and semimagical in its treatment of refractory concentration decreased, in the absence of further bleedascites. 5,6 However, it is not free of problems. It has ing. Intravascular hemolysis was diagnosed, based on caused a broad spectrum of complications 7 and has these findings and the appearance of schistocytes in the been plagued by a variety of malfunctions. 8,9 The most peripheral blood smear, reticulocytosis, hypohaptoglobincommon of the complications are procedural, primarily emia, hemosiderinuria, and a negative Coomb's test. Worsperforations of the capsule of the liver or of abdominal ening HE required a liver transplantation, after which the organs that are associated with intra-abdominal hem-hemolysis promptly subsided. At the time of liver transorrhage. Infection, arrhythmias, thrombosis, misplaced plantation, they observed in the explanted liver that the or migrating stents, and nephrotoxicity are common Wallstent protruded into the portal and hepatic veins. The occurrences.intrahepatic portion of the stent was completely endotheliBased on the similarity of TIPS to portosystemic alized, but the extrahepatic, intravenous ends of the stent, anastomoses (PSA) it was predicted that portosystemic which consisted of bare wires, protruded into the portal encephalopathy (PSE) would be a common metabolic and hepatic veins (Fig. 1). They postulated that the hemocomplication. Indeed, 25% to 35% of patients who have lysis resulted from traumatic injury to erythrocytes flowundergone TIPS implantation have promptly devel-ing through the naked steel wires of the stent that prooped new or worsened PSE. 10 The frequency and sever-truded into the veins. In the absence of a positive Coomb's ity of PSE after PSA, whether spontaneous, surgical, test, which excludes antibodies to gamma globulins, macor interventional are proportional to the size of the roglobulins and complement, of spur cells, of sepsis, of shunt. 11 Most descriptions of post-TIPS PSE mention hepatocellular carcinoma or of disseminated intravascular that it tends to be mild, easily treatable, and of short hemo...

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“…Several complications in placement of TIPS have been reported, including stent dislodgement, haemobilia, liver capsule rupture, intraabdominal bleeding, encephalopathy, haemolysis, cholestasis, renal failure and sepsis [1][2][3]. We describe a patient who developed pulmonary hypertension 1.5 yrs after TIPS insertion.…”

mentioning

confidence: 96%

“…Eur Respir J., 1996Respir J., , 9, 1562 Transjugular intrahepatic portosystemic shunt (TIPS) has recently been introduced as treatment for consequences of portal hypertension, such as variceal haemorrhage and refractory ascites [1,2]. Several complications in placement of TIPS have been reported, including stent dislodgement, haemobilia, liver capsule rupture, intraabdominal bleeding, encephalopathy, haemolysis, cholestasis, renal failure and sepsis [1][2][3]. We describe a patient who developed pulmonary hypertension 1.5 yrs after TIPS insertion.…”

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confidence: 99%

Pulmonary hypertension after transjugular intrahepatic portosystemic shunt (TIPS)

Heijde¹,

Laméris²,

Berg³

et al. 1996

European Respiratory Journal

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We reported the case of a patient in whom severe, and ultimately fatal, pulmonary hypertension developed 1.5 yrs after transjugular intrahepatic portosystemic shunt (TIPS).Pulmonary artery pressures were not affected by 100% oxygen, prostacyclin or nifedipine. Postmortem examinations showed pulmonary and vascular abnormalities typical of pulmonary hypertension.Pulmonary artery pressures should be measured in each patient with otherwise not readily explained dyspnoea following transjugular intrahepatic portosystemic shunt. Eur Respir J., 1996Respir J., , 9, 1562 Transjugular intrahepatic portosystemic shunt (TIPS) has recently been introduced as treatment for consequences of portal hypertension, such as variceal haemorrhage and refractory ascites [1,2]. Several complications in placement of TIPS have been reported, including stent dislodgement, haemobilia, liver capsule rupture, intraabdominal bleeding, encephalopathy, haemolysis, cholestasis, renal failure and sepsis [1][2][3]. We describe a patient who developed pulmonary hypertension 1.5 yrs after TIPS insertion. Case reportA 45 year old man with alcoholic liver cirrhosis was admitted to hospital due to bleeding from large gastric varices. After initial control of the bleeding with endoscopic sclerotherapy, a TIPS was inserted. After a year without medical problems, the patient was readmitted due to bleeding originating from a gastric varix. Recatheterization with phlebography revealed subtotal stent stenosis and a large coronary vein feeding gastric varices. A second stent was inserted inside the old one and embolization of the coronary vein was performed.Six months later, the patient presented with exertional dyspnoea and syncope. His medication consisted of spironolactone, furosemide, lactulose and ranitidine. At physical examination, arterial and central venous pressures were normal. Heart rate was 84 beats·min -1 . No jaundice, ascites, oedema, cyanosis or finger-clubbing was found. Normal heart sounds and a short ejection murmur at the left sternal border were noted. The lungs were normal on examination. The liver was felt 5 cm below the right costal margin.Laboratory investigation showed mild iron deficiency anaemia (haemoglobin 5.2 mmol·L -1 ). Arterial blood gas analysis was normal. Ventilatory function was normal: total lung capacity (TLC) 7.89 L, and forced expiratory volume in one second (FEV1) 3.67 L (95% predicted). Transfer factor of the lungs for carbon monoxide was normal. Doppler ultrasound examination suggested normal TIPS function. In contrast to the chest radiographic examination obtained before the first TIPS, the heart was increased in size and lung vessels were prominent. The lung parenchyma showed no abnormalities. Cardiac ultrasound showed dilation of right atrium and right ventricle, with insufficiency of the tricuspid valve. The function and dimensions of the left ventricle were considered normal. Pulmonary ventilation and perfusion scans were normal. Continuous registration of oxygen saturation during the night revealed ...

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Haemolysis and cholestasis following implantation of a transjugular intrahepatic portosystemic shunt

Cited by 6 publications

References 0 publications

Hemolytic Anemia following Stent-Graft Transjugular Intrahepatic Portosystemic Shunt Creation

Hemolytic Anemia following Stent-Graft Transjugular Intrahepatic Portosystemic Shunt Creation

Hemolysis after transjugular intrahepatic portosystemic shunting: The naked stent syndrome

Pulmonary hypertension after transjugular intrahepatic portosystemic shunt (TIPS)

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