Transjugular intrahepatic portocaval shunt placed through the strut of an inferior vena cava stent in a patient with Budd–Chiari syndrome: a technical modification

Abstract

Transjugular intrahepatic portocaval shunt (TIPS) is performed in patients with symptomatic Budd-Chiari syndrome (BCS) who do not have repairable hepatic veins. We report the case of a patient who had an inferior vena cava (IVC) stent placed previously as part of the management for BCS, and who subsequently required TIPS. The TIPS tract was created through the strut of the previously placed IVC stent; the TIPS stent was placed after dilatation of the liver parenchyma as well as the strut of the IVC stent. This novel technique of "strutplasty" of a previously placed stent as part of TIPS has not been reported in the literature.

Transjugular intrahepatic portosystemic shunt for Budd–Chiari syndrome: techniques, indications and results on 51 Chinese patients from a single centre

“…In the latter cases, TIPS procedure is often planned after percutaneous recanalization. Thus, a pre‐existent IVC stent appears to be an obstacle for the puncture needle and catheter to access the portal vein, thereby substantially increasing the technical difficulty of TIPS procedure .…”

Technical and Medium-Term Clinical Outcomes of Transjugular Intrahepatic Portosystemic Shunt with Fluoroscopy and Additional Trans-abdominal Ultrasound Guidance

“…If there was a previously placed stent in the path of TIPS creation, strut plasty was performed and TIPS was created. 8 9 Stents would have been placed to treat BCS in IVC or hepatic veins.…”

“…Among the BCS patients, 86 of the 91 cases (95%) had refractory ascites, while five (5%) had variceal bleeding. In patients with BCS, the median BCS TIPS prognostic index was 3.7 (1.1-6.5) and the median MELD score was 12 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). The indication for TIPS in patients with VOD was refractory ascites; the patient with CPSS was asymptomatic but underwent prophylactic TIPS prior to the closure of the shunt.…”