Skip to main content

Advertisement

SpringerLink
Log in

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

  • Technical Note
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

References

  1. Haskal ZJ, Rees CR, Ring EJ et al (1997) Reporting standards for transjugular intrahepatic portosystemic shunts. J Vasc Interv Radiol 8:289–297

    Article  CAS  PubMed  Google Scholar 

  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 163:439–444

    CAS  PubMed  Google Scholar 

  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 196:341–347

    CAS  PubMed  Google Scholar 

  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 15:1219–1230

    PubMed  Google Scholar 

  5. Ferral H, Banks B, Wholey M et al (1998) Techniques for transjugular intrahepatic portosystemic shunt revision. AJR Am J Roentgenol 189:1041–1047

    Google Scholar 

  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 4:441–443

    Article  CAS  PubMed  Google Scholar 

  7. Haskal ZJ, Cope C (1994) Combined transhepatic and transvenous approach to hepatic vein stenosis after transjugular intrahepatic portosystemic shunt (TIPS). Cardiovasc Interv Radiol 17:173–175

    Article  CAS  Google Scholar 

  8. Haskal ZJ, Ring EJ, LaBerge JM et al (1992) Role of parallel transjugular intrahepatic portosystemic shunts in patients with persistent portal hypertension. Radiology 185:813–817

    CAS  PubMed  Google Scholar 

  9. Hausegger KA, Sternthal HM, Klein GE et al (1994) Transjugular intrahepatic portosystemic shunt: angiographic follow-up and secondary interventions. Radiology 191:177–181

    CAS  PubMed  Google Scholar 

  10. Sterling KM, Darcy MD (1997) Stenosis of transjugular intrahepatic portosystemic shunts: presentation and management. AJR Am J Roentgenol 168:239–244

    CAS  PubMed  Google Scholar 

  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 207:683–693

    CAS  PubMed  Google Scholar 

  12. Cura M, Cura A, Suri R et al (2008) Cause of TIPS dysfunction. AJR Am J Roentgenol 191:1751–1757

    Article  PubMed  Google Scholar 

  13. Haskal ZJ, Duszak R Jr, Furth EE (1996) Transjugular intrahepatic transcaval portosystemic shunt: the gun-sight approach. J Vasc Interv Radiol 7:139–142

    Article  CAS  PubMed  Google Scholar 

  14. Seong CK, Kim YJ, Shin TB et al (2001) Transcaval TIPS in patients with failed revision of occluded previous TIPS. Korean J Radiol 2:204–209

    Article  CAS  PubMed  Google Scholar 

  15. Darcy MD, Vesely TM, Picus D et al (1992) Percutaneous revision of an acutely thrombosed transjugular intrahepatic portosystemic shunt. J Vasc Interv Radiol 3:77–82

    Article  CAS  PubMed  Google Scholar 

  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 5:467–471

    Article  CAS  PubMed  Google Scholar 

  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 19:368–370

    Article  CAS  Google Scholar 

  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 13:405–408

    Article  PubMed  Google Scholar 

  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 8:539–548

    Article  CAS  PubMed  Google Scholar 

  20. Haskal ZJ (1999) Improved patency of transjugular intrahepatic portosystemic shunts in humans: creation and revision with PTFE stent-grafts. Radiology 213:759–766

    CAS  PubMed  Google Scholar 

  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 22:298–304

    Article  CAS  Google Scholar 

  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 25:365–372

    Article  Google Scholar 

  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 13:1255–1259

    Article  PubMed  Google Scholar 

  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 231:820–830

    Article  PubMed  Google Scholar 

  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 20:180–185

    Article  PubMed  Google Scholar 

  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 26:189–191

    Article  CAS  Google Scholar 

  27. Radeleff B, Sommer CM, Schawo S et al (2008) Acute liver failure after a late TIPS revision. Cardiovasc Interv Radiol 31:209–214

    Article  Google Scholar 

Download references

Conflict of Interest Statement

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Diagnostic Radiology, Aachen University Hospital, RWTH Aachen University, Pauwelsstr. 20, 52074, Aachen, Germany

    Toshihiro Tanaka, Rolf W. Günther, Peter Isfort & Andreas H. Mahnken

  2. Applied Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Pauwelsstr. 20, 52074, Aachen, Germany

    Toshihiro Tanaka, Peter Isfort & Andreas H. Mahnken

  3. Department of Radiology, Nara Medical University, Nara, Japan

    Toshihiro Tanaka & Kimihiko Kichikawa

Authors
  1. Toshihiro Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rolf W. Günther
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Peter Isfort
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kimihiko Kichikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andreas H. Mahnken
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Toshihiro Tanaka.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tanaka, T., Günther, R.W., Isfort, P. et al. Pull-Through Technique for Recanalization of Occluded Portosystemic Shunts (TIPS): Technical Note and Review of the Literature. Cardiovasc Intervent Radiol 34, 406–412 (2011). https://doi.org/10.1007/s00270-010-9874-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-010-9874-2

Keywords

Search

Navigation