Transcaval TIPS in Patients with Failed Revision of Occluded Previous TIPS.
- Author:
Chang Kyu SEONG
1
;
Yong Joo KIM
;
Tae Beom SHIN
;
Hyo Yong PARK
;
Tae Hun KIM
;
Duk Sik KANG
Author Information
- Publication Type:Original Article ; Evaluation Studies
- Keywords: Hypertension, portal; Interventional procedures, complications; Shunts, portosystemic
- MeSH: Esophageal and Gastric Varices/*surgery; Feasibility Studies; Gastrointestinal Hemorrhage/*surgery; Human; Male; Middle Age; Portal Vein/radiography/*surgery; Portasystemic Shunt, Surgical/*methods; *Portasystemic Shunt, Transjugular Intrahepatic; Reoperation; Stents; Treatment Failure; Vascular Patency; Vena Cava, Inferior/radiography/*surgery
- From:Korean Journal of Radiology 2001;2(4):204-209
- CountryRepublic of Korea
- Language:English
- 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.
