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Transcaval transjugular intrahepatic portosystemic shunt: preliminary clinical results.

Lee KH, Lee DY, Won JY, Park SJ, Kim JK, Yoon W - Korean J Radiol (2003 Jan-Mar)

Bottom Line: Technical and functional success was achieved in all patients.The entry site into liver parenchyma from the inferior vena cava was within 2 cm of the atriocaval junction.Procedure-related complications included the death of one patient due to hemoperitoneum despite the absence of contrast media spillage at tractography, and another suffered reversible hepatic encephalopathy.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT

Objective: To determine the feasibility of transcaval transjugular intrahepatic portosystemic shunt (TIPS) creation in patients with unusual anatomy between the hepatic veins and portal bifurcation, and inaccessible or inadequate hepatic veins.

Materials and methods: Transcaval TIPS, performed in six patients, was indicated by active variceal bleeding (n=2), recurrent variceal bleeding (n=2), intractable ascites (n=1), and as a bridge to liver transplantation (n=1). The main reasons for transcaval rather than classic TIPS were the presence of an unusually acute angle between the hepatic veins and the level of the portal bifurcation (n=3), hepatic venous occlusion (n=2), and inadequate small hepatic veins (n=1).

Results: Technical and functional success was achieved in all patients. The entry site into liver parenchyma from the inferior vena cava was within 2 cm of the atriocaval junction. Procedure-related complications included the death of one patient due to hemoperitoneum despite the absence of contrast media spillage at tractography, and another suffered reversible hepatic encephalopathy.

Conclusion: In patients with unusual anatomy between the hepatic veins and portal bifurcation, and inaccessible or inadequate hepatic veins, transcaval TIPS creation is feasible.

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Related in: MedlinePlus

Case 4. A 38-year-old woman who was a candidate for liver transplantation.A. Contrast-enhanced CT scan shows a thrombosed hepatic vein (arrow), inhomogeneous parenchymal enhancement, and a substantial amount of ascites, compatible with Budd-Chiari syndrome.B, C. IVC venogram (B) and angiogram (C) obtained after direct intrahepatic puncture show the collateralization typical of Budd-Chiari syndrome.D. Transcaval TIPS was performed due to occlusion of hepatic veins.
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Figure 2: Case 4. A 38-year-old woman who was a candidate for liver transplantation.A. Contrast-enhanced CT scan shows a thrombosed hepatic vein (arrow), inhomogeneous parenchymal enhancement, and a substantial amount of ascites, compatible with Budd-Chiari syndrome.B, C. IVC venogram (B) and angiogram (C) obtained after direct intrahepatic puncture show the collateralization typical of Budd-Chiari syndrome.D. Transcaval TIPS was performed due to occlusion of hepatic veins.


Transcaval transjugular intrahepatic portosystemic shunt: preliminary clinical results.

Lee KH, Lee DY, Won JY, Park SJ, Kim JK, Yoon W - Korean J Radiol (2003 Jan-Mar)

Case 4. A 38-year-old woman who was a candidate for liver transplantation.A. Contrast-enhanced CT scan shows a thrombosed hepatic vein (arrow), inhomogeneous parenchymal enhancement, and a substantial amount of ascites, compatible with Budd-Chiari syndrome.B, C. IVC venogram (B) and angiogram (C) obtained after direct intrahepatic puncture show the collateralization typical of Budd-Chiari syndrome.D. Transcaval TIPS was performed due to occlusion of hepatic veins.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2698056&req=5

Figure 2: Case 4. A 38-year-old woman who was a candidate for liver transplantation.A. Contrast-enhanced CT scan shows a thrombosed hepatic vein (arrow), inhomogeneous parenchymal enhancement, and a substantial amount of ascites, compatible with Budd-Chiari syndrome.B, C. IVC venogram (B) and angiogram (C) obtained after direct intrahepatic puncture show the collateralization typical of Budd-Chiari syndrome.D. Transcaval TIPS was performed due to occlusion of hepatic veins.
Bottom Line: Technical and functional success was achieved in all patients.The entry site into liver parenchyma from the inferior vena cava was within 2 cm of the atriocaval junction.Procedure-related complications included the death of one patient due to hemoperitoneum despite the absence of contrast media spillage at tractography, and another suffered reversible hepatic encephalopathy.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT

Objective: To determine the feasibility of transcaval transjugular intrahepatic portosystemic shunt (TIPS) creation in patients with unusual anatomy between the hepatic veins and portal bifurcation, and inaccessible or inadequate hepatic veins.

Materials and methods: Transcaval TIPS, performed in six patients, was indicated by active variceal bleeding (n=2), recurrent variceal bleeding (n=2), intractable ascites (n=1), and as a bridge to liver transplantation (n=1). The main reasons for transcaval rather than classic TIPS were the presence of an unusually acute angle between the hepatic veins and the level of the portal bifurcation (n=3), hepatic venous occlusion (n=2), and inadequate small hepatic veins (n=1).

Results: Technical and functional success was achieved in all patients. The entry site into liver parenchyma from the inferior vena cava was within 2 cm of the atriocaval junction. Procedure-related complications included the death of one patient due to hemoperitoneum despite the absence of contrast media spillage at tractography, and another suffered reversible hepatic encephalopathy.

Conclusion: In patients with unusual anatomy between the hepatic veins and portal bifurcation, and inaccessible or inadequate hepatic veins, transcaval TIPS creation is feasible.

Show MeSH
Related in: MedlinePlus