Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Transcaval TIPS in Patients with Failed Revision of Occluded Previous TIPS

  • Chang Kyu Seong (Department of Radiology, Kyungpook National University School of Medicine) ;
  • Yong Joo Kim (Department of Radiology, Kyungpook National University School of Medicine) ;
  • Tae Beom Shin (Department of Radiology, Kyungpook National University School of Medicine) ;
  • Hyo Yong Park (Department of Radiology, Kyungpook National University School of Medicine) ;
  • Tae Hun Kim (Department of Radiology, Kyungpook National University School of Medicine) ;
  • Duk Sik Kang (Department of Radiology, Kyungpook National University School of Medicine)
  • Received : 2001.05.23
  • Accepted : 2001.09.28
  • Published : 2001.12.31
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Abstract

Objective: To determine the feasibility of transcaval transjugular intrahepatic portosystemic shunt (TIPS) in patients with occluded previous TIPS. Materials and Methods: Between February 1996 and December 2000 we performed five transcaval TIPS procedures in four patients with recurrent gastric cardiac variceal bleeding. All four had occluded TIPS, which was between the hepatic and portal vein. The interval between initial TIPS placement and revisional procedures with transcaval TIPS varied between three and 31 months; one patient underwent transcaval TIPS twice, with a 31-month interval. After revision of the occluded shunt failed, direct cavoportal puncture at the retrohepatic segment of the IVC was attempted. Results: Transcaval TIPS placement was technically successful in all cases. In three, tractography revealed slight leakage of contrast materials into hepatic subcapsular or subdiaphragmatic pericaval space. There was no evidence of propagation of extravasated contrast materials through the retroperitoneal space or spillage into the peritoneal space. After the tract was dilated by a bare stent, no patient experienced trans-stent bleeding and no serious procedure-related complications occurred. After successful shunt creation, variceal bleeding ceased in all patients. Conclusion: Transcaval TIPS placement is an effective and safe alternative treatment in patients with occluded previous TIPS and no hepatic veins suitable for new TIPS.

Keywords

References

  1. Zemel G, Katzen BT, Becker GJ, et al. Percutaneous transjugular portosystemic shunt. JAMA 1991;266:390-393 https://doi.org/10.1001/jama.1991.03470030090029
  2. Sanyal AJ, Freedman AM, Shiffman ML, Purdum PP 3rd, Luketic VA, Cheatham AK. Portosystemic encephalopathy after transjugular intrahepatic portosystemic shunt: results of a prospective controlled study. Hepatology 1994;20:46-55
  3. Somberg KA, Riegler JL, LaBerge JM, et al. Hepatic encephalopathy after transjugular intrahepatic portosystemic shunts: incidence and risk factors. Am J Gastroenterol 1995;90:549-555
  4. LaBerge JM, Ring EJ, Gordon RL, et al. Creation of transjugular intrahepatic portosystemic shunt (TIPS) with the Wallstent endoprosthesis: results in 100 patients. Radiology 1993;187:413-420 https://doi.org/10.1148/radiology.187.2.8475283
  5. Haskal ZJ, Pentecost MJ, Soulen MC, Shlansky-Goldberg RD, Baum RA, Cope C. Transjugular intrahepatic portosystemic shunt stenosis and revision: early and midterm results. AJR 1994;163:439-444 https://doi.org/10.2214/ajr.163.2.8037046
  6. Coldwell D, Ring E, Rees C, et al. Multicenter investigation of the role of transjugular intrahepatic portosystemic shunts in the management of portal hypertension. Radiology 1995;196:335-340 https://doi.org/10.1148/radiology.196.2.7617842
  7. Saxon RS, Ross PL, Mendel-Hartvig J, et al. Transjugular intrahepatic portosystemic shunt patency and the importance of stenosis location in the development of recurrent symptoms. Radiology 1998;207(3):683-693 https://doi.org/10.1148/radiology.207.3.9609891
  8. Sterling KM, Darcy MD. Stenosis of transjugular intrahepatic portosystemic shunts: presentation and management. AJR 1997;168:239-244 https://doi.org/10.2214/ajr.168.1.8976952
  9. Hausegger KA, Sternthal HM, Klein GE, Karaic R, Stauber R, Zenker G. Transjugular intrahepatic portosystemic shunt: angiographic follow-up and secondary interventions. Radiology 1994;191:177-181 https://doi.org/10.1148/radiology.191.1.8134566
  10. LaBerge JM, Ferrell LD, Ring EJ, Gordon RL. Histopathologic study of stenotic and occluded transjugular intrahepatic portosystemic shunts. J Vasc Interv Radiol 1993;4:779-786 https://doi.org/10.1016/S1051-0443(93)71972-7
  11. Saxon RR, Mendel-Hartvig J, Corless CL, et al. Bile duct injury as a major cause of stenosis and occlusion in TIPS: comparative histologic analysis in humans and swine. J Vasc Interv Radiol 1996;7:487-497 https://doi.org/10.1016/S1051-0443(96)70789-3
  12. Saxon RR, Timmermans H, Uchida BT, et al. Stent grafts for revision of TIPS stenoses and occlusions: A clinical pilot study. J Vasc Interv Radiol 1997;8:539-548 https://doi.org/10.1016/S1051-0443(97)70606-7
  13. Martin M, Zajko AB, Orons PD, et al. Transjugular intrahepatic portosystemic shunt in the management of variceal bleeding: indications and clinical results. Surgery 1993;114:719-726
  14. Lind CD, Malisch TW, Chong WK, et al. Incidence of shunt occlusion or stenosis following transjugular intrahepatic portosystemic shunt placement. Gastroenterology 1994;106:1277-1283 https://doi.org/10.1016/0016-5085(94)90020-5
  15. Nazarian GK, Ferral H, Castaneda-Zuniga WR, et al. Development of stenoses in transjugular intrahepatic portosystemic shunts. Radiology 1994;192:231-234 https://doi.org/10.1148/radiology.192.1.8208944
  16. Haskal ZJ, Duszak R, Further EE. Transjugular intrahepatic transcaval portosystemic shunt: the gun-sight approach. J Vasc Interv Radiol 1996;7:139-142 https://doi.org/10.1016/S1051-0443(96)70750-9
  17. Rogopoulos A, Gavelli A, Sakai H, McNamara M, Huguet C. Transjugular intrahepatic portosystemic shunt for Budd-Chiari syndrome after failure of surgical shunting. Arch Surg 1995;130:227-228 https://doi.org/10.1001/archsurg.1995.01430020117024
  18. Soares GM, Murphy TP. Transcaval TIPS: Indications and anatomic considerations. J Vasc Interv Radiol 1999;10:1233-1238 https://doi.org/10.1016/S1051-0443(99)70224-1
  19. Chang RW, Shan-Quan S, Yen WW. An applied anatomical study of the retrohepatic segment of the inferior vena cava. J Anat 1989;164:41-47
  20. Camargo AM, Teixeira GG, Ortale JR. Anatomy of the ostia venae hepaticae and the retrohepatic segment of the inferior vena cava, Part 1. J Anat 1996;188:59-64
  21. McCowan TC, Hummel MM, Schmucker T, Goertzen TC, Culp WC, Habbe TG. Cardiac perforation and tamponade during transjugular intrahepatic portosystemic shunt placement. Cardiovasc Intervent Radiol 2000;23:298-311 https://doi.org/10.1007/s002700010072