Advertisement

CardioVascular and Interventional Radiology

, Volume 34, Issue 2, pp 406–412 | Cite as

Pull-Through Technique for Recanalization of Occluded Portosystemic Shunts (TIPS): Technical Note and Review of the Literature

  • Toshihiro TanakaEmail author
  • Rolf W. Günther
  • Peter Isfort
  • Kimihiko Kichikawa
  • Andreas H. Mahnken
Technical Note

Abstract

Transjugular intrahepatic portosystemic shunt (TIPS) dysfunction is an important problem after creation of shunts. Most commonly, TIPS recanalization is performed via the jugular vein approach. Occasionally it is difficult to cross the occlusion. We describe a hybrid technique for TIPS revision via a direct transhepatic access combined with a transjugular approach. In two cases, bare metal stents or polytetrafluoroethylene (PTFE)-covered stent grafts had been placed in TIPS tract previously, and they were completely obstructed. The tracts were inaccessible via the jugular vein route alone. In each case, after fluoroscopy or computed tomography-guided transhepatic puncture of the stented segment of the TIPS, a wire was threaded through the shunt and snared into the right jugular vein. The TIPS was revised by balloon angioplasty and additional in-stent placement of PTFE-covered stent grafts. The patients were discharged without any complications. Doppler sonography 6 weeks after TIPS revision confirmed patency in the TIPS tract and the disappearance of ascites. We conclude that this technique is feasible and useful, even in patients with previous PTFE-covered stent graft placement.

Keywords

Recanalization Transjugular intrahepatic portosystemic shunt (TIPS) Stenting/stent graft 

Notes

Conflict of Interest Statement

The authors declare that they have no conflict of interest.

References

  1. 1.
    Haskal ZJ, Rees CR, Ring EJ et al (1997) Reporting standards for transjugular intrahepatic portosystemic shunts. J Vasc Interv Radiol 8:289–297CrossRefPubMedGoogle Scholar
  2. 2.
    Haskal ZJ, Pentecost MJ, Soulen MC et al (1994) Transjugular intrahepatic portosystemic shunt stenosis and revision: early and midterm results. AJR Am J Roentgenol 163:439–444PubMedGoogle Scholar
  3. 3.
    Nishimine K, Saxon R, Kichikawa K et al (1995) Improved transjugular intrahepatic portosystemic shunt patency with PTFE-covered stent-grafts: experimental results in swine. Radiology 196:341–347PubMedGoogle Scholar
  4. 4.
    Charon JM, Alaeddin FH, Plimpalwar SA et al (2004) Results of a retrospective multicenter trial of the Viatorr expanded polyetrafluuoroethylene-covered stent-graft for transjugular intrahepatic portosystemic shunt creation. J Vasc Interv Radiol 15:1219–1230PubMedGoogle Scholar
  5. 5.
    Ferral H, Banks B, Wholey M et al (1998) Techniques for transjugular intrahepatic portosystemic shunt revision. AJR Am J Roentgenol 189:1041–1047Google Scholar
  6. 6.
    Gordon RL, LeBerge JM, Ring EJ et al (1993) Recanalization of occluded intrahepatic portosystemic shunts: use of the Colapinto needle. J Vasc Interv Radiol 4:441–443CrossRefPubMedGoogle Scholar
  7. 7.
    Haskal ZJ, Cope C (1994) Combined transhepatic and transvenous approach to hepatic vein stenosis after transjugular intrahepatic portosystemic shunt (TIPS). Cardiovasc Interv Radiol 17:173–175CrossRefGoogle Scholar
  8. 8.
    Haskal ZJ, Ring EJ, LaBerge JM et al (1992) Role of parallel transjugular intrahepatic portosystemic shunts in patients with persistent portal hypertension. Radiology 185:813–817PubMedGoogle Scholar
  9. 9.
    Hausegger KA, Sternthal HM, Klein GE et al (1994) Transjugular intrahepatic portosystemic shunt: angiographic follow-up and secondary interventions. Radiology 191:177–181PubMedGoogle Scholar
  10. 10.
    Sterling KM, Darcy MD (1997) Stenosis of transjugular intrahepatic portosystemic shunts: presentation and management. AJR Am J Roentgenol 168:239–244PubMedGoogle Scholar
  11. 11.
    Saxon RR, Ross PL, Mendel-Hartvig J et al (1998) Transjugular intrahepatic portosystemic shunt patency and the importance of stenosis location in the development of recurrent symptoms. Radiology 207:683–693PubMedGoogle Scholar
  12. 12.
    Cura M, Cura A, Suri R et al (2008) Cause of TIPS dysfunction. AJR Am J Roentgenol 191:1751–1757CrossRefPubMedGoogle Scholar
  13. 13.
    Haskal ZJ, Duszak R Jr, Furth EE (1996) Transjugular intrahepatic transcaval portosystemic shunt: the gun-sight approach. J Vasc Interv Radiol 7:139–142CrossRefPubMedGoogle Scholar
  14. 14.
    Seong CK, Kim YJ, Shin TB et al (2001) Transcaval TIPS in patients with failed revision of occluded previous TIPS. Korean J Radiol 2:204–209CrossRefPubMedGoogle Scholar
  15. 15.
    Darcy MD, Vesely TM, Picus D et al (1992) Percutaneous revision of an acutely thrombosed transjugular intrahepatic portosystemic shunt. J Vasc Interv Radiol 3:77–82CrossRefPubMedGoogle Scholar
  16. 16.
    Schmitz-Rode T, Vorwerk D, Marschall HU et al (1994) Portal vein thrombosis after occlusion of transjugular intrahepatic portosystemic shunt: recanalization with the impeller catheter. J Vasc Interv Radiol 5:467–471CrossRefPubMedGoogle Scholar
  17. 17.
    Cope C, Baum RA, Haskal ZJ (1996) Balloon occlusion portography to diagnose new-onset left hepatic vein thrombosis and widening of an existing Wallstent TIPS by Palmaz stent for recurrent portal hypertension and variceal bleeding. Cardiovasc Interv Radiol 19:368–370CrossRefGoogle Scholar
  18. 18.
    Kuhlman CG, Patel NH, Johnson MS et al (2002) Use of balloon-expandable stents in transjugular intrahepatic portosystemic shunts in cases of Wallstent endoprosthesis technical failure and revision of shunt senosis. J Vasc Interv Radiol 13:405–408CrossRefPubMedGoogle Scholar
  19. 19.
    Saxon RR, Timmermans HA, Uchida BT et al (1997) Stent-grafts for revision of TIPS stenoses and occlusion: a clinical pilot study. J Vasc Interv Radiol 8:539–548CrossRefPubMedGoogle Scholar
  20. 20.
    Haskal ZJ (1999) Improved patency of transjugular intrahepatic portosystemic shunts in humans: creation and revision with PTFE stent-grafts. Radiology 213:759–766PubMedGoogle Scholar
  21. 21.
    Sze DY, Vestring T, Liddell RP et al (1999) Recurrent TIPS failure associated with biliary fistulae: treatment with PTFE-covered stents. Cardiovasc Interv Radiol 22:298–304CrossRefGoogle Scholar
  22. 22.
    Cejna M, Peck-Radosavljevic M, Thurnher S et al (2002) ePTFE-covered stent-grafts for revision of obstructed transjugular intrahepatic portosystemic shunt. Cardiovasc Interv Radiol 25:365–372CrossRefGoogle Scholar
  23. 23.
    Haskal ZJ, Weintraub JL, Susman J (2002) Recurrent TIPS thrombosis after polyethylene stent-graft use and salvage with polytetrafluoroehylene stent-graft. J Vasc Interv Radiol 13:1255–1259CrossRefPubMedGoogle Scholar
  24. 24.
    Rossi P, Salvatori FM, Fanelli F et al (2004) Polytetrafluoroethylene-covered nitinol stent-graft for transjugular intrahepatic portosystemic shunt creation: 3-year experience. Radiology 231:820–830CrossRefPubMedGoogle Scholar
  25. 25.
    Jung HS, Kalva SP, Greenfield AJ et al (2009) TIPS: comparison of shunt patency and clinical outocomes between bare stents and expanded polytetrafluoroethylene stent-grafts. J Vasc Interv Radiol 20:180–185CrossRefPubMedGoogle Scholar
  26. 26.
    Bloss MF, Lenz J Jr, Gemery J (2003) Combined transabdominal and transjugular recanalization of thrombosed TIPS, portal and proximal splenic veins. Cardiovasc Interv Radiol 26:189–191CrossRefGoogle Scholar
  27. 27.
    Radeleff B, Sommer CM, Schawo S et al (2008) Acute liver failure after a late TIPS revision. Cardiovasc Interv Radiol 31:209–214CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2010

Authors and Affiliations

  • Toshihiro Tanaka
    • 1
    • 2
    • 3
    Email author
  • Rolf W. Günther
    • 1
  • Peter Isfort
    • 1
    • 2
  • Kimihiko Kichikawa
    • 3
  • Andreas H. Mahnken
    • 1
    • 2
  1. 1.Department of Diagnostic Radiology, Aachen University HospitalRWTH Aachen UniversityAachenGermany
  2. 2.Applied Medical Engineering, Helmholtz-Institute for Biomedical EngineeringRWTH Aachen UniversityAachenGermany
  3. 3.Department of RadiologyNara Medical UniversityNaraJapan

Personalised recommendations