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

Salvalaggio, Paolo R.O.; Koffron, Alan J.; Fryer, Jonathan P.; Abécassis, Michaël

doi:10.1002/lt.20292

Cited by 13 publications

(3 citation statements)

References 23 publications

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“…TIPS extension into the IVC or right atrium can complicate transplantation by hindering vena cava clamp placement during hepatectomy, potentially resulting in hemorrhage and increased transfusion requirements (9). Radical transplant procedures, including partial transplantation of the right atrium and open cardiotomy, have been described due to misplaced and migrated shunts (10,11).…”

Section: Discussionmentioning

confidence: 99%

“…Although less invasive than surgery, percutaneous removal has associated procedural risks, including further migration to a more hazardous location, vessel dissection, perforation, valvular damage, induction of conduction abnormalities, possible cardiac perforation, and unraveling of the stent components with worsening luminal compromise (7,10,12). Difficulties can be encountered as described by Te et al, whereupon open cardiotomy for TIPS removal was performed secondary to ventricular tachycardia during attempted percutaneous removal.…”

Section: Discussionmentioning

confidence: 99%

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Endovascular Caudal Retraction of the Cranial End of a Misplaced Viatorr Tips Prior to Liver Transplantation

Ray

Savage

Klintmalm³

et al. 2012

Baylor University Medical Center Proceedings

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Transjugular intrahepatic portosystemic shunt (TIPS) extension far into the inferior vena cava (IVC) or the right atrium may complicate or preclude orthotopic liver transplantation depending on the space available for placement of a hemostatic clamp in the suprahepatic IVC. Until 2004, most TIPS were performed with bare metal stents, which integrate into the vessel wall, making percutaneous or intraoperative repositioning uncertain. Most TIPS are currently created with stent grafts that have an outer fabric to increase shunt patency and prevent endothelial ingrowth. We describe the first known manipulation of a covered stent graft prior to transplantation. The stent graft, which extended well into the IVC, was snared from a femoral approach and deflected caudally in order to document feasibility and nonadherence to the vein wall prior to definitive surgical planning of liver transplantation. Provisions were made for endovascular retraction during actual transplant surgery 9 weeks later, but this became unnecessary when manual retraction of the exposed liver enabled suprahepatic IVC clamping. Due to the nonadherent nature of the outer graft material, compared with a bare metal stent, extension of a stent graft into the IVC or right atrium may not preclude transplantation, and intraoperative endovascular retraction may be considered.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Endovascular Caudal Retraction of the Cranial End of a Misplaced Viatorr Tips Prior to Liver Transplantation

Ray

Savage

Klintmalm³

et al. 2012

Baylor University Medical Center Proceedings

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“…A inadequate placement of endoprostheses used for TIPS creation requires additional interventions. In case of migration of the endoprosthesis, need of advanced surgical procedures has been reported [ 2 – 4 ]. We reported successful retrieval of two dislodged Viatorrs in one patient and one misplaced endoprosthesis in another patient, with the use of endovascular methods.…”

Section: Introductionmentioning

confidence: 99%

Endovascular Removal of the Viatorr Stent-Grafts. Report of Two Cases

2015

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SummaryBackgroundThe dysfunction of misplaced or dislodged endovascular endoprostheses, may be a serious complication, and endovascular removal may be attempted in some cases.Case ReportA Viatorr® stent-graft (Gore, Flagstaff, AR, USA) is an endoprosthesis designed and commonly used for creation of a transjugular intrahepatic portosystemic shunt (TIPS). Two Viatorrs were accidentally dislodged during TIPS procedure. In another patient, the Viatorr was malpositioned, with its distal end being placed in the bile duct. All endoprostheses were successfully removed without serious complications.ConclusionsRemoval of a misplaced or dislodged Viatorr endoprosthesis is possible using interventional methods.

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Management of Pretransplant Patients

Durand¹

2007

Textbook of Hepatology

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

Cited by 13 publications

References 23 publications

Endovascular Caudal Retraction of the Cranial End of a Misplaced Viatorr Tips Prior to Liver Transplantation

Endovascular Caudal Retraction of the Cranial End of a Misplaced Viatorr Tips Prior to Liver Transplantation

Endovascular Removal of the Viatorr Stent-Grafts. Report of Two Cases

Management of Pretransplant Patients

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