Successful Management of an Unusual Complication after Transjugular Intrahepatic Portosystemic Shunt Procedure (original) (raw)
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Fatal liver infarction after transjugular intrahepatic portosystemic shunt procedure
Liver International, 2001
Hepatic infarction is a rare disease. We describe here a cirrhotic Radiology, 3 Department of Gastroenterology and patient with end-stage renal failure and recurrent tense ascites with fatal the 4 Institute of Pathology, The Chaim Sheba hepatic infarction after transjugular intrahepatic portosystemic shunt Medical Center, Tel Aviv University, Tel (TIPS) procedure. Abdominal ultrasound, radionuclide liver scan, ab-Hashomer, Israel dominal computed tomography scan, and finally liver biopsy established the diagnosis. The mechanism causing the infarct is not clear. However, as the infarct appeared after the patient had an episode of shock and disseminated intravascular coagulation, it could well be that the concomi-Key words: ascites -liver infarction -TIPStant hepatic arterial insufficiency contributed to the infarct. Physicians treatment complications should be aware of this possible catastrophic complication.
Liver Transplantation, 1996
582 days (range, 1 to 1,095), 35 patients underwent transplantation, 21 patients died, and 29 patients are still alive and did not undergo transplantation. Technical complications were observed in 7% of patients and new onset of clinical encephalopathy in 37%. The 30-day mortality rate after TIPS was 13%. Actuarial survival was 60% at 1 and 3 years. Child class C and urgent TIPS were shown to be two independent predictor factors for mortality. TIPS was shown to be a valuable procedure, not only as a bridge to OLT but also as palliation for bleeding from portal hypertension in patients who were not candidates for either surgical shunt or OLT. However, its role in bleeding patients with acceptable liver function needs further investigation. Copyright 0 1996 by the American Association for the Study of Liver Diseases procedure and the possible morbidity and mortality associated with shunt procedure itself. We report our experience in patients who underwent TIPS regardless of their eligibility for OLT with an emphasis on the incidence of technical complications associated with this procedure, assessment of clinical course, and long-term survival.
The transjugular intrahepatic portosystemic shunt
Journal of Hepatology - J HEPATOL, 1996
URMG TEE last 20 years improvement in endoscopic techniques have resulted in more than 90% success in the management of acute variceal bleeding. However, in the prevention of recurrence of variceal bleeding endoscopic treatment is of limited efficacy, with a l-year rebleeding rate' of more than 40% (1). In patients with insufficient response to endoscopic therapy, surgical shunts and devascularization operations have for many years been used as salvage treatments, but they have become less acceptable in recent years because of their high operative mortality and postoperative morbidity, especially in the many Child-class B and C patients. In 1988, the transjugular intrahepatic portosystemic stent-assisted shunt (TIPS) was introduced into clinical practice (2) and has since then enjoyed rapid acceptance around the world. This may in part be due to the fascinating technique of this novel intervention, but it may also be a consequence of the unfavorable results of the pre-existing therapies. The results presently available suggest that TIPS has a higher efficacy and a lower morbidity and mortality than endoscopic and surgical treatments, respectively. Its major limitations, namely shunt failure and hepatic encephalopathy, must be overcome by specific medication, improved stents and better selection of patients. This review concentrates on the two major indications, variceal bleeding and refractory ascites, and summarizes the results of major studies. TIPS for variceal rebleeding Uncontrolled studies Since its first description in 1988 (2) numerous papers have been published on TIPS for variceal
La Radiologia …, 2009
Purpose. The authors present a retrospective analysis of a large series of patients who underwent transjugular intrahepatic portosystemic shunt (TIPS) placement. Materials and methods. Between March 1992 and December 2006, 658 patients were referred to our centre for TIPS placement. Indications for the procedure were digestive tract bleeding (52.8%), refractory ascites (35.3%), preservation of portal vein patency prior to liver transplantation (3.0%) and thrombosis of the suprahepatic veins (2.3%). Other indications (6.6%) included pleural ascites, portal thrombosis and hepatorenal and hepatopulmonary syndromes. All patients were evaluated with colour Doppler ultrasonography and in a few cases with computed tomography. The portal system was punctured under sonographic guidance. Wallstent, Palmaz and Nitinol thermosensitive stents were used. Embolisation of persistent varices was performed in 6.8% of cases. Results. Technical success was 98.9%. During a 1,500-day follow-up, the cumulative incidence of stent revision was 25.7% (Nitinol), 32.9% (Wallstent) and 1.8% (Palmaz). Mortality rates were 31.1%, 38.5% and 56.4%, respectively. The technical complications included six cases of heart failure, six of haematobilia, three of stent migration, two of intrahepatic haematoma and one of haemoperitoneum. Eight patients with severe portosystemic encephalopathy (PSE) were treated with a reduction stent. Riassunto Obiettivo. Gli autori presentano un'analisi retrospettiva di un'ampia casistica di pazienti sottoposti a TIPS. Materiali e metodi. Sono giunti al nostro centro per la TIPS 658 pazienti tra il marzo 1992 e il dicembre 2006. Le indicazioni alla procedura erano: sanguinamento digestivo (52,8%), ascite refrattaria (35,3%), "tutela" della pervietà portale pre-trapianto epatico (3,0%), trombosi delle vene sovraepatiche (2,3%). Altre indicazioni (6,6%) erano ascite pleurica, trombosi portale, sindrome epato-renale ed epato-polmonare. I pazienti sono stati studiati con ecocolor doppler, raramente con tomografia computerizzata; la puntura portale è stata ecoguidata. Sono stati impiegati stent Palmaz, Wallstent e termoespandibili. Nel 6,8% dei casi sono state embolizzate varici persistenti. Risultati. Il successo tecnico è stato del 98,9%. Durante un follow-up di 1500 giorni, l'incidenza cumulativa di reintervento sugli stent è stata del 25,7% (Nitinol), 32,9% (Wallstent) e 1,8% (Palmaz); la mortalità è stata rispettivamente 31,1%, 38,5% e 56,4%. Le complicanze tecniche sono state: 6 insufficienze cardiache, 6 emobilie, 3 migrazioni di stent, 2 ematomi intraepatici ed 1 emoperitoneo. Otto pazienti con encefalopatia portosistemica (PSE) grave sono stati trattati con stent riduttore. Conclusioni. La TIPS è sicura ed efficace, può rappresentare un ponte all'OLT. L'ecografia ha un ruolo fondamentale nello studio preliminare, durante la puntura
Arquivos de Gastroenterologia, 2012
CONTEXT: Transjugular intrahepatic portosystemic shunt (TIPS) is the non-surgical treatment option with low level of morbi-mortality and possibility of accomplishment in patients with severe hepatic dysfunction which aims at decompressing the portal system treating or reducing the portal hypertension complications. OBJECTIVE: Outline the profile analyze global and early mortality, and the complications presented by cirrhotic patients who underwent TIPS for treatment of digestive hemorrhage by portal hypertension. METHOD: Retrospective study based on the data bank of cirrhotic patients' medical reports, who underwent TIPS for digestive hemorrhage by portal hypertension treatment who did not respond to clinical endoscopic treatment, and were assisted from 1998 to 2010 in the Liver Transplant Service at a university hospital. The study was approved by the Committee of Ethics and Research. RESULTS: The sample was comprised of 72 (84.7%) patients, being 57 (79.2%) males, average age ...
The American Journal of Surgery, 1996
BACKGROUND: Transjugular intrahepatic portosystemic shunts (TIPS) are an established method for the treatment of the complications of portal hypertension. Recent reports have suggested that TIPS require frequent follow-up and may interfere with orthotopic liver transplantation (OLT). METHODS: Retrospective chart review was performed of ultrasound studies, angiographic studies, and complications of the first 100 patients treated consecutively with TIPS from February 1992 through October 1995. RESULTS: Ninety-seven patients had functional TIPS. Thirty-one percent of patients treated emergently survived, significantly less than the 96% survival of elective patients. Fifty percent of the shunts were found to require angioplasty by 5 months. Seventeen patients treated with OLT did well, without intraoperative bleeding problems, and are alive. CONCLUSIONS: The TIPS method treats successfully the complications of portal hypertension but requires careful follow-up. The technique may be used prior to OLT. For non-OLT candidates, the cost effectiveness of TIPS versus surgical shunting remains in question. 0 7996 by Excerpta Me&a, Inc.
Transjugular intrahepatic portosystemic shunt: Where are we?
The Turkish journal of gastroenterology, 2014
Background/Aims: The purpose of this study was to evaluate the technical/hemodynamic success, complications, and biochemical/ hematologic consequences of transjugular intrahepatic portosystemic shunt (TIPS) created with 10-mm bare stents in our patients. Materials and Methods: Data of 27 cirrhotic patients (18 men and 9 women; mean age, 39.7±18.7 years) with a median MELD score 14 (range 7-31) treated with TIPS between January 2000 and August 2010 were evaluated retrospectively. Results: The indications were refractory bleeding varices in 48.2%, refractory ascites in 22.2%, and Budd-Chiari syndrome in 29.6% of the patients. Technical and hemodynamic success rates were 96.3% and 92.3%, respectively. Mean portosystemic pressure gradient decreased from 21.5±5.3 mm Hg to 9±2.7 mm Hg (p<0.05). The rate of primary stent patency was 76.9% 1 year after the procedure. No statistically significant difference in shunt dysfunction was found between the groups of patients treated for Budd-Chiari syndrome and other indications (p>0.05). One patient (3.7%) had shunt dysfunction due to thrombosis within 24 hours. New and/or worsening hepatic encephalopathy occurred in 34.6% of patients. Increased age (≥40 years) was significantly related to hepatic encephalopathy in both univariate and multivariate analyses (p<0.05). Thirty-day mortality rate and 1-year transplant-free survival rate were 0% and 80.7%, respectively. Conclusion: Transjugular intrahepatic portosystemic shunt procedure is a safe treatment for many patients with cirrhosis, but post-procedure hepatic encephalopathy and shunt dysfunction are still problems. Especially, patient age should be taken into consideration in predicting hepatic encephalopathy risk.
Current use of transjugular intrahepatic portosystemic shunts
Current Gastroenterology Reports, 2003
The principal indication for transjugular intrahepatic portosystemic shunts (TIPS) continues to be rescue therapy for variceal hemorrhage that cannot be controlled by endoscopic or medical therapy. TIPS provide no survival advantage in prevention of rebleeding or refractory ascites. The indications for TIPS continue to expand, however, especially for Budd-Chiari syndrome and hydrothorax. Other more novel indications include bleeding portal hypertensive gastropathy or ectopic varices, Budd-Chiari syndrome, veno-occlusive disease, hepatorenal syndrome, hepatopulmonary syndrome, hepatocellular carcinoma, and polycystic liver disease. Great strides have been made recently in models to predict mortality and complications following TIPS placement. Graft stents hold promise based on early studies. Finally, complications are common and may be life threatening.