PDF herunterladen
CC-BY-NC-ND 4.0 · Journal of Clinical Interventional Radiology ISVIR 2017; 01(01): 040-042
DOI: 10.1055/s-0036-1597653
Case Report
Indian Society of Vascular and Interventional Radiology

Parallel Transjugular Intrahepatic Portosystemic Shunt (TIPS) Creation in a Patient with a Preexisting Unsalvageable Occluded TIPS and Refractory Variceal Bleeding

Krantikumar Rathod
1   Department of Vascular and Interventional Radiology, Bombay Hospital and Medical Research Center, Mumbai, India
2   Department of Vascular and Interventional Radiology, Seth G. S. Medical College and K. E. M. Hospital, Mumbai, India
,
Bhavesh Popat
2   Department of Vascular and Interventional Radiology, Seth G. S. Medical College and K. E. M. Hospital, Mumbai, India
,
Pankaj Barai
1   Department of Vascular and Interventional Radiology, Bombay Hospital and Medical Research Center, Mumbai, India
,
Deepak Amrapurkar
3   Department of Gastroenterology, Bombay Hospital and Medical Research Center, Mumbai, India
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
28. Juli 2017 (online)

Auch verfügbar auf
   Lizenzen und Reprints

Abstract

Transjugular intrahepatic portosystemic shun (TIPS) dysfunction is usually secondary to acute thrombosis within the stent, pseudointimal hyperplasia in the TIPS parenchymal tract, or intimal hyperplasia in the outflow hepatic vein. Several methods have been used in treating TIPS dysfunction, including balloon angioplasty, stent insertion, and the creation of a parallel TIPS. We report a case of refractory variceal bleeding in which a parallel TIPS was successfully created after failure to recanalize the preexisting occluded TIPS.

Keywords

parallel TIPS - TIPS dysfunction - variceal bleeding
 

  • References

  • 1 Garcia-Tsao G, Bosch J. Management of varices and variceal hemorrhage in cirrhosis. N Engl J Med 2010; 362 (09) 823-832
    CrossrefPubMedSuche in Google Scholar
  • 2 Nishimine K, Saxon RR, Kichikawa K. , et al. Improved transjugular intrahepatic portosystemic shunt patency with PTFE-covered stent-grafts: experimental results in swine. Radiology 1995; 196 (02) 341-347
    CrossrefPubMedSuche in Google Scholar
  • 3 Tanihata H, Saxon RR, Kubota Y. , et al. Transjugular intrahepatic portosystemic shunt with silicone-covered Wallstents: results in a swine model. Radiology 1997; 205 (01) 181-184
    CrossrefPubMedSuche in Google Scholar
  • 4 Cura M, Cura A, Suri R, El-Merhi F, Lopera J, Kroma G. Causes of TIPS dysfunction. AJR Am J Roentgenol 2008; 191 (06) 1751-1757
    CrossrefPubMedSuche in Google Scholar
  • 5 Rössle M, Gerbes AL. TIPS for the treatment of refractory ascites, hepatorenal syndrome and hepatic hydrothorax: a critical update. Gut 2010; 59 (07) 988-1000
    CrossrefPubMedSuche in Google Scholar
  • 6 García-Pagán JC, Caca K, Bureau C. , et al; Early TIPS (Transjugular Intrahepatic Portosystemic Shunt) Cooperative Study Group. Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med 2010; 362 (25) 2370-2379
    CrossrefPubMedSuche in Google Scholar
  • 7 Feldstein VA, Patel MD, LaBerge JM. Transjugular intrahepatic portosystemic shunts: accuracy of Doppler US in determination of patency and detection of stenoses. Radiology 1996; 201 (01) 141-147
    CrossrefPubMedSuche in Google Scholar
  • 8 Tzeng WS, Wu RH, Lin CY. , et al. Prediction of mortality after emergent transjugular intrahepatic portosystemic shunt placement: use of APACHE II, Child-Pugh and MELD scores in Asian patients with refractory variceal hemorrhage. Korean J Radiol 2009; 10 (05) 481-489
    CrossrefPubMedSuche in Google Scholar
  • 9 Clark TW, Agarwal R, Haskal ZJ, Stavropoulos SW. The effect of initial shunt outflow position on patency of transjugular intrahepatic portosystemic shunts. J Vasc Interv Radiol 2004; 15 (2 Pt 1): 147-152
    CrossrefPubMedSuche in Google Scholar
  • 10 Dabos KJ, Stanley AJ, Redhead DN, Jalan R, Hayes PC. Efficacy of balloon angioplasty, restenting, and parallel shunt insertion for shunt insufficiency after transjugular intrahepatic portosystemic stent-shunt (TIPSS). Minim Invasive Ther Allied Technol 1998; 7: 287-293
    CrossrefPubMedSuche in Google Scholar
  • 11 Helmy A, Redhead DN, Stanley AJ, Hayes PC. The natural history of parallel transjugular intrahepatic portosystemic stent shunts using uncovered stent: the role of host-related factors. Liver Int 2006; 26 (05) 572-578
    CrossrefPubMedSuche in Google Scholar