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Semin intervent Radiol 2024; 41(01): 092-096
DOI: 10.1055/s-0044-1779710
Technical Corner

A Simple “Involute” Technique for Successful Removal of a Caudally Migrated “Viatorr” Stent Graft

Vellia Zhou
1   Tufts University School of Medicine, Boston, Massachusetts
,
Mark Reddick
2   Radiology Associates of the Fox Valley, Neenah, Wisconsin
,
Daniel Lamus
3   Division of Interventional Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
,
Ronald S. Arellano
4   Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Sanjeeva P. Kalva
4   Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
› Author Affiliations Funding This study was not supported by any funding.
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Inadvertent misplacement or migration of a “Viatorr” stent graft (W.L. Gore & Associates, Inc. Flagstaff, AR) during transjugular intrahepatic portosystemic shunt (TIPS) creation can occur either during stent deployment or subsequent manipulation of balloons or catheters within the stent.[1] [2] [3] Minor degrees of stent migration in the cephalad or caudal direction often have no clinical consequence. However, major cephalad migration of the stent graft can result in outflow obstruction of the inferior vena cava or problems during hepatic venous anastomosis of the transplanted liver.[4] The reported techniques for the removal of a centrally migrated stent graft involve using a loop snare to capture the cephalad portion of the stent and retrieving it into a large caliber sheath,[2] using forceps-like device for holding the proximal end to allow subsequent passage of a snare,[5] or forceful pulling of the stent into the sheath and surgical removal of the stent graft.[3]

Caudal migration of the stent graft can result in occlusion of the major portal vein branch. Major caudal migration can result in diverting the entire portal flow into the TIPS. It can also interfere with portal vein anastomosis during liver transplantation. Removal of caudally migrated TIPS stent is often difficult as the cranial segment of the stent graft is within the parenchymal tract, limiting the ability to snare the hepatic venous end of the stent graft for retrieval. Balloon-assisted repositioning of the stent graft is rarely successful. In this case, we report successful removal of a caudally migrated TIPS stent with the “involute” technique.

Other Conflicts of Interest

S.P.K. reports grants from NIH, BD, Black Swan, and Trisalus for Institution; reports royalties from Elsevier, Springer, and Thieme for himself; reports consulting fees from Penumbra, Okami Medical, Boston Scientific, Medtronic, Instylla, and BD for himself; reports stock from Biogen Inc, Clover Health Investments Corp, Inovio Pharmaceuticals, Moderna Inc, Pfizer Inc, Novavax Inc., Orphazyme, Cassava Sciences Inc., Vivos Therapeutics Inc., Ardelyx Inc., Althea Health, Sarepta Therapeutics, Clover Health Investments Corp., CureVac BV, Immunoprecise Antibodies Ltd., Infinity Pharmaceuticals Inc., Zymergen Inc., BioNTech SE, Trillium Therapeutics Inc., Theravance Biopharma Inc., Doximity Inc., Eargo Inc., Allogent Therapeutics Inc., NRx Pharmaceuticals Inc., Atea pharmaceuticals Inc., for himself and spouse.




Publication History

Article published online:
14 March 2024

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