Inadvertent arteriovenous stenting during transjugular intrahepatic portosystemic shunt procedure and the importance of hepatic artery perfusion
Penetrating the hepatic artery during transjugular intrahepatic portosystemic shunt (TIPS) is a relatively frequent but almost always benign complication. We report a patient in whom the right hepatic artery, originating from the superior mesenteric artery, was inadvertently catheterized and stented. The arteriovenous fistula was treated with a detachable balloon positioned within the hepatic artery. A second TIPS was attempted and successfully created during the same session. The patient died of cardiac failure, attributed to rapid resolution of massive ascites after TIPS with circulatory overload. At autopsy, the liver distal to the arterial occlusion balloon was infarcted, illustrating the importance of hepatic artery perfusion in liver cirrhosis.
Key wordsHypertension, portal Interventional procedures, complications Liver, cirrhosis Liver, interventional procedures Shunts, portosystemic
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- 1.Rössle M, Haag K, Ochs A, Sellinger M, Nöldge G, Perarnau J-M, Berger E, Blum U, Gabelmann A, Hauenstein K, Langer M, Gerok W (1994) The transjugular intrahepatic porto-systemic stent-shunt procedure for variceal bleeding. N Engl J Med 330:165–171Google Scholar
- 3.Richter GM, Roeren T, Roessle M, Palmaz JC (1992) Transjugular intrahepatic portosystemic stent shunt. Baillière's Clin Gastroenterol 6:403–419Google Scholar
- 4.Ferral H, Bjarnason H, Wegryn SA, Rengel GJ, Nazarian GK, Rank JM, Tadavarthy SM, Hunter DW, Castañeda-Zúñiga WR (1993) Refractory ascites: Early experience in treatment with transjugular intrahepatic portosystemic shunt. Radiology 189:795–801Google Scholar
- 5.Rousseau H, Vinel JP, Bilbao JI, Longo JM, Maquin P, Zozaya JM, García-Villarreal L, Coustet B, Railhac N, Railhac JJ, Alvarez-Cienfuegos J, Prieto J, Joffre F, Pascal JP (1994) Transjugular intrahepatic portosystemic shunts using the Wallstent endoprosthesis: A follow-up study. Cardiovasc Intervent Radiol 17:7–11PubMedGoogle Scholar
- 7.Hawkins IF, Kerns SR, Sabatelli FW (1993) TIPS: Fine needle system. (abstract) Cardiovasc Intervent Radiol 16:S25Google Scholar
- 8.Darcy MD, Picus D, Vesely TM, Hicks ME, Dick L, Mayhle M (1993) Efficacy and complications of transjugular intrahepatic portosystemic shunts (abstract). Radiology 189:S227Google Scholar
- 9.Haskal ZJ, Pentecost MJ, Rubin RA (1993) Hepatic arterial injury after transjugular intrahepatic portosystemic shunt placement: Report of two cases. Radiology 188:85–88Google Scholar
- 10.Sanchez RB, Roberts AC, Valji K, Lengle S, Bookstein JJ (1992) Wallstent misplaced during transjugular placement of an intrahepatic portosystemic shunt: Retrieval with a loop snare. AJR 159:129–130Google Scholar
- 11.Young AT, Tadavarthy SM, Yedlicka JW Jr, Hunter DW, Becker GJ, Herrera MA, Castañeda F, Amplatz K, Castañeda-Zúñiga WR (1992) Embolotherapy: Agents, equipment and technique. In: Castañeda-Zúñiga WR, Tadavarthy SM (eds) Interventional radiology, 2nd ed. Williams and Wilkins, Baltimore, pp 18–19Google Scholar
- 12.Hadengue A, Moreau R, Sogni P, Soupison T, Vilgrain V, Lebrec D (1992) Risk of adverse hemodynamic effects after intraepatic shunts (TIPS): Preliminary results. (abstract) Hepatology 16:241AGoogle Scholar
- 13.Azoulay D, Castaing D, Eyraud D, Martino W, Bumuth H (1993) Hemodynamic response to transjugular portosystemic shunt in the cirrhotic patient. (abstract) Gastroenterology 104:A873Google Scholar