Transjugular Intrahepatic Portosystemic Shunt Through the Strut of a Previously Placed Stent: Technical Feasibility and Long-Term Follow-Up Results

Ahmed, Munawwar; Keshava, Shyamkumar Nidugala; Moses, Vinu; Chiramel, George Koshy; Mammen, Suraj; Eapen, CE; Zachariah, Uday

doi:10.1007/s00270-018-2033-x

Cited by 6 publications

(4 citation statements)

References 11 publications

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“…Simultaneous wire access into the lumen of the existing TIPS stent graft and IVC with “kissing” balloon dilatation was utilized to avoid stent stenosis or occlusion. 10…”

Section: Discussionmentioning

confidence: 99%

Recanalization and Reconstruction of a Chronically Occluded Inferior Vena Cava Through an Existing Transjugular Intrahepatic Portosystemic Shunt in the Setting of Budd-Chiari Syndrome

Talaie

Jalaeian

Rostambeigi

et al. 2021

Vasc Endovascular Surg

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Budd-Chiari syndrome (BCS) results from the occlusion or flow reduction in the hepatic veins or inferior vena cava and can be treated with transjugular intrahepatic portosystemic shunt when hepatic vein recanalization fails.1-3 Hypercoagulable patients with primary BCS are predisposed to development of new areas of thrombosis within the TIPS shunt or IVC. This case details a patient with BCS, pre-existing TIPS extending to the right atrium, and chronic retrohepatic IVC thrombosis who underwent sharp recanalization of the IVC with stenting into the TIPS stent bridging the patient until his subsequent hepatic transplantation.

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“…Simultaneous wire access into the lumen of the existing TIPS stent graft and IVC with “kissing” balloon dilatation was utilized to avoid stent stenosis or occlusion. 10…”

Section: Discussionmentioning

confidence: 99%

Recanalization and Reconstruction of a Chronically Occluded Inferior Vena Cava Through an Existing Transjugular Intrahepatic Portosystemic Shunt in the Setting of Budd-Chiari Syndrome

Talaie

Jalaeian

Rostambeigi

et al. 2021

Vasc Endovascular Surg

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“…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.…”

Section: Methodsmentioning

confidence: 99%

“…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.…”

Section: Demographicsmentioning

confidence: 99%

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

Keshava

Moses

Sharma

et al. 2021

Indian J Radiol Imaging

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Background and Objective The aim of the study is to evaluate the technical and clinical outcomes of transjugular intrahepatic portosystemic shunt (TIPS) performed with additional transabdominal ultrasound guidance. Material and Methods Patients who underwent TIPS between January 2004 to January 2020 in our center were studied. Technical, hemodynamic, angiographic, and clinical outcome were recorded up to 1 year of follow-up. Results TIPS was attempted in 162 patients (median [range] age 37[3–69] years; 105 were males and 57 were females; Etiology: Budd-Chiari syndrome [BCS] 91, cirrhosis 65, symptomatic acute portal venous thrombosis [PVT] 3, veno-occlusive disease [VOD] 2, congenital portosystemic shunt [CPSS] 1) during the study period. Indication for TIPS was refractory ascites in 135 patients (BCS 86, cirrhosis 49) and variceal bleed in 21 patients (BCS 5, cirrhosis 16). Technical success was seen in 161 of the 162 (99.4%) patients. The tract was created from hepatic vein in 55 patients and inferior vena cava (IVC) in 106 patients. Complications within 1 week post TIPS were seen in 29 of the 162 (18%) patients, of whom one developed unexplained arrhythmia and hypotension and died. Of the patients with available follow-up, clinical success was noted in 120 (81%), while 14 (9%) patients had partial nonresponse and six (4%) had complete nonresponse. Eight (5%) patients died during the follow-up period. Conclusion The technical success of TIPS creation with additional transabdominal ultrasound guidance is very high with low peri-procedural complication rate. It has enabled the inclusion of a wider spectrum of cases like acute PVT and obliterated hepatic veins which were otherwise considered contraindications.

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“…Multiple IR procedures may be required over a period of time in patients of BCS. 61 A percutaneous peritoneovenous shunt is a palliative option in a selective subgroup of patients with refractory ascites who are not suitable for other specific treatment options. 62 Imaging thus has a diagnostic role to identify the etiology and the severity of PHT.…”

Section: Diagnosis Of Portal Hypertensionmentioning

confidence: 99%

Imaging Approach to Portal Hypertension

Augustine

John

Simon

et al. 2023

Journal of Gastrointestinal and Abdominal Radiology

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Increase in portal venous pressure (termed portal hypertension) is seen in a variety of liver diseases. Imaging tests are useful to detect portal hypertension and identify its cause. Noninvasive tests like abdominal ultrasound and Doppler studies are routinely done in clinical practice for this indication. Cross-sectional studies like computed tomography and magnetic resonance imaging are especially useful to delineate morphological abnormalities in the liver. Invasive tests like assessment of hepatic venous pressure gradient are done less frequently for specific indications. Distinctive imaging findings help differentiate the different causes of portal hypertension like cirrhosis and vascular liver disorders like noncirrhotic portal hypertension, extrahepatic portal venous obstruction, and Budd–Chiari syndrome. Radiological interventions are increasingly used to treat complications of portal hypertension like refractory ascites or refractory bleeding from gastroesophageal varices.

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Transjugular Intrahepatic Portosystemic Shunt Through the Strut of a Previously Placed Stent: Technical Feasibility and Long-Term Follow-Up Results

Abstract: TIPS through the strut of a previously placed stent is technically feasible with good long-term primary patency and clinical outcome.

Cited by 6 publications

References 11 publications

Recanalization and Reconstruction of a Chronically Occluded Inferior Vena Cava Through an Existing Transjugular Intrahepatic Portosystemic Shunt in the Setting of Budd-Chiari Syndrome

Recanalization and Reconstruction of a Chronically Occluded Inferior Vena Cava Through an Existing Transjugular Intrahepatic Portosystemic Shunt in the Setting of Budd-Chiari Syndrome

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

Imaging Approach to Portal Hypertension

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