Transjugular Intrahepatic Portosystemic Shunt Creation in a 5.5-kg Infant with Refractory Variceal Hemorrhage: Case Report and Review of the Literature

Tabriz, D.; Lazarowicz, Michael; Beasley, Genie; Toskich, Beau B.

doi:10.1016/j.jvir.2015.09.020

Cited by 7 publications

(3 citation statements)

References 8 publications

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“…A few previous case reports have reported successful creation of TIPS in infants, but as demonstrated in the first case presented in this paper, TIPS creation in this population can often be technically challenging. This is due to the small size of the peripheral intrahepatic vessels in infants and possible unfavorable anatomic relationships between the portal and hepatic veins.…”

Section: Discussionmentioning

confidence: 83%

Portosystemic shunt as a bridge to liver transplantation in infants: A comparison of two techniques

Yoeli

Galván

Ashton

et al. 2017

Pediatric Transplantation

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Portosystemic shunts can serve as a bridge to liver transplantation in patients with end‐stage liver disease by providing portal decompression to treat life‐threatening variceal bleeding and prevent recurrent episodes until an organ becomes available. The conventional TIPS procedure, however, is technically challenging to perform in infants due to the small size of their intrahepatic vasculature. We report two cases of emergent creation of portosystemic shunts as a bridge to liver transplantation in infants with life‐threatening variceal bleeding using a conventional TIPS technique in the first case and a percutaneous DIPS technique in the other. Both procedures were successful at reducing the portosystemic pressure gradient and preventing further variceal bleeds until a liver transplant could be performed. The novel percutaneous DIPS procedure is a valuable alternative to the conventional TIPS in infants, as it is better suited for small or challenging intrahepatic vascular anatomy.

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Section: Discussionmentioning

confidence: 83%

Portosystemic shunt as a bridge to liver transplantation in infants: A comparison of two techniques

Yoeli

Galván

Ashton

et al. 2017

Pediatric Transplantation

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“…33 Scattered reports describe a variety of nonstandard constructs for very small children undergoing TIPS. [34][35][36] The authors currently place traditional 8 or 10 mm partially covered stent-grafts for most pediatric patients undergoing TIPS and consider stent-constrained stent-grafts for small pediatric patients with limited hepatic reserve and uncertain transplant candidacy. Nonstandard stents and stent-grafts are considered for patients with main portal vein diameters <7 mm or hepatic vein and parenchymal tract lengths less than the available shortest Viatorr covered length (4 cm).…”

Section: Stent Selectionmentioning

confidence: 99%

Pediatric Transjugular Intrahepatic Portosystemic Shunts

et al. 2017

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Transjugular intrahepatic portosystemic shunt (TIPS) creation offers potentially life-saving portal decompression regardless of patient age or size, but has been underutilized in pediatric patients to date. Experience has therefore been limited, and the full clinical benefit in this population is yet to be realized. Those wishing to embark on pediatric TIPSs would benefit not only from significant experience in adult TIPSs, but also from an awareness of challenges posed by the unique pediatric population. We herein review the etiologies and manifestations of portal hypertension more common in children, highlight some of the technical nuances of creating TIPSs in smaller anatomy, and summarize the existing literature on the topic. As extrahepatic portal vein occlusion (EHPVO) occurs with greater frequency in pediatric patients, special attention is paid to this condition and its associated challenges.

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“…There are many treatment strategies, but transjugular intrahepatic portosystemic shunt (TIPS) is minimally invasive and, most importantly, could alleviate portal hypertension directly. Though TIPS placement has been described as being able to treat portal hypertension in children (4), due to its technical difficulty and the small size of young children, to date, no report has been published delineating TIPS as the treatment for pediatric CTPV under the age of 5 years of age. Herein, we describe the first case of CTPV in a 26-month old boy treated by TIPS.…”

Section: Introductionmentioning

confidence: 99%

Cavernous Transformation of the Portal Vein in a 26-Month Old Boy Treated by Transjugular Intrahepatic Portosystemic Shunt: A Case Report

et al. 2019

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Cavernous transformation of portal vein (CTPV) is the main cause of portal hypertension and its related variceal bleeding in children. Transjugular intrahepatic portosystemic shunt (TIPS) was not reported to treat CTPV for children younger than 5 years old. In this case report, the patient was a 26-month-old boy who presented with hematemesis and melena due to CTPV. Even after azygoportal disconnection, repeated hematemesis as well-melena still occurred. After careful evaluation, we performed TIPS under general anesthesia for him. The procedure was uneventful, and 6-mm stents were inserted. Six months after TIPS, there was no recurrence of bleeding, and no procedure-related event happened. The follow-up esophagogastroduodenoscopy proved dramatic remission of varices, indicating a successful outcome. We believe TIPS could be safely placed for young children to manage variceal bleeding due to CTPV.

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Transjugular Intrahepatic Portosystemic Shunt Creation in a 5.5-kg Infant with Refractory Variceal Hemorrhage: Case Report and Review of the Literature

Cited by 7 publications

References 8 publications

Portosystemic shunt as a bridge to liver transplantation in infants: A comparison of two techniques

Portosystemic shunt as a bridge to liver transplantation in infants: A comparison of two techniques

Pediatric Transjugular Intrahepatic Portosystemic Shunts

Cavernous Transformation of the Portal Vein in a 26-Month Old Boy Treated by Transjugular Intrahepatic Portosystemic Shunt: A Case Report

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