Transjugular Intrahepatic Portosystemic Shunt in patients after orthotopic liver transplantation (OLTx) due to life threatening gastrointestinal hemorrhage. A single-center experience based on three cases and literature review

2018 ◽  
Vol 91 (2) ◽  
pp. 38-44
Author(s):  
Magdalena Januszewicz ◽  
Inga Włodarczyk-Pruszyńska ◽  
Krzysztof Milczarek ◽  
Katarzyna Rowińska-Berman ◽  
Krzysztof Zieniewicz ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Portosystemic Shunt ◽  
Liver Graft ◽  
Shunt System ◽  
Single Center Experience ◽  
Life Saving ◽  
Chiari Syndrome ◽  
Life Threatening ◽  
Intrahepatic Portosystemic Shunt

Background: Transjugular intrahepatic portosystemic shunt system (TIPS) is a well-recognized method of treatment of symptomatic portal hypertension in patients awaiting liver transplantation. Effectiveness of the TIPS treatment in patients after liver transplantation is still not fully established. Indications for both groups of patients, with and without liver graft, are similar and include bleeding from gastrointestinal varices, ascites, pleural effusion and Budd-Chiari syndrome. Feasibility of TIPS in emergency treatment in patients after OLTx due to life threatening hemorrhage is not well described. Materials and methods: Patients after OLTx performed using classical, non piggy-back technique had severe hemorrhages from gastrointestinal varices due to loss of grafts function. Patients were in an unstable condition, required blood transfusions on admittance and monitoring in Intensive Care Unit. TIPS were implanted urgently, after unsuccessful endoscopic treatment, as a life-saving procedure. Results: In all cases procedure was successfully completed. The bleeding did not reoccur during postoperative course. Conclusion: TIPS procedure appears to be justified, as a bridge to a planned retransplantation, or as a treatment of choice in patients disqualified from re-transplantation. Emergency performance of the TIPS procedure, as a treatment for acute variceal bleeding should still be considered individually for each patient and only as a procedure leading to further treatment.

Treatment of acute portomesenteric venous thrombosis with thrombectomy through a transjugular intrahepatic portosystemic shunt: a single-center experience

2017 ◽  
Vol 59 (8) ◽  
pp. 953-958 ◽  
Author(s):  
Kerstin Rosenqvist ◽  
Charlotte Ebeling Barbier ◽  
Fredrik Rorsman ◽  
Per Sangfelt ◽  
Rickard Nyman
Keyword(s):  
Venous Thrombosis ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Symptom Relief ◽  
Portosystemic Shunt ◽  
Single Center Experience ◽  
Threatening Condition ◽  
Life Threatening ◽  
Intrahepatic Portosystemic Shunt ◽  
Portomesenteric Venous Thrombosis ◽  
Age Range

Background Acute portomesenteric venous thrombosis (PMVT) is a potentially life-threatening condition and urgent treatment is required. Purpose To retrospectively evaluate the efficacy and safety of treating acute PMVT by the creation of a transjugular intrahepatic portosystemic shunt (TIPS) followed by thrombectomy. Material and Methods Six patients (all men, age range = 39–51 years) presenting with acute PMVT were treated with transjugular thrombectomy (TT) through a TIPS created in the same session. The intervention included iterated venography through the TIPS one to three times within the first week after diagnosis and repeated thrombectomy if needed (n = 5). Results Recanalization was successful with persistent blood flow through the main superior mesenteric vein, portal vein, and TIPS in all six patients. Five patients were treated primarily with thrombectomy through a TIPS with clinical improvement. The final patient was initially treated with surgical thrombectomy and bowel resection. TIPS and TT was performed two days after surgery due to re-thrombosis but the patient deteriorated and died of multi-organ failure. Procedure-related complications were transient hematuria (n = 3) and transient encephalopathy (n = 2). In-hospital time was <14 days in four of the five patients with primary TIPS and TT. No sign of re-thrombosis was noted during follow-up (mean = 18 months, range = 8–28 months). Conclusion Thrombectomy through a TIPS is feasible and can be effective in recanalization and symptom-relief in acute PMVT.

Recanalization and Reconstruction of a Chronically Occluded Inferior Vena Cava Through an Existing Transjugular Intrahepatic Portosystemic Shunt in the Setting of Budd-Chiari Syndrome

2021 ◽  
pp. 153857442110020
Author(s):  
Reza Talaie ◽  
Hamed Jalaeian ◽  
Nassir Rostambeigi ◽  
Anthony Spano ◽  
Jafar Golzarian
Keyword(s):  
Inferior Vena Cava ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Inferior Vena ◽  
Vena Cava ◽  
Portosystemic Shunt ◽  
Hepatic Veins ◽  
Budd Chiari Syndrome ◽  
Chiari Syndrome ◽  
Intrahepatic Portosystemic Shunt ◽  
The Right

Budd-Chiari syndrome (BCS) results from the occlusion or flow reduction in the hepatic veins or inferior vena cava and can be treated with transjugular intrahepatic portosystemic shunt when hepatic vein recanalization fails.1-3 Hypercoagulable patients with primary BCS are predisposed to development of new areas of thrombosis within the TIPS shunt or IVC. This case details a patient with BCS, pre-existing TIPS extending to the right atrium, and chronic retrohepatic IVC thrombosis who underwent sharp recanalization of the IVC with stenting into the TIPS stent bridging the patient until his subsequent hepatic transplantation.

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