Repeat Stent Placement through Lateral Fenestration of the Existing Dysfunctioning DIPS Stent Graft: An Alternative to Parallel TIPS/DIPS Procedure in a Case of Blocked Primary TIPS/DIPSFunding This study was not supported by any funding.
A complication of transjugular and direct intrahepatic portosystemic stent (TIPS and DIPS) graft is stent blockage. Routinely described procedures for shunt revision include angioplasty, deployment of endoprosthesis, catheter-directed thrombolysis, or rarely performing a second parallel TIPS/DIPS. We describe a case of hepatic vein outflow tract obstruction who presented with DIPS blockage. We performed a revision where a new stent was placed by a lateral puncture through the fenestration of the existing dysfunctioning DIPS stent graft. In our opinion, this alternate technique has theoretical advantages over the conventionally described parallel TIPS/DIPS as it prevents the creation of a completely new long hepatic parenchymal tract.
Keywordstransjugular intrahepatic portosystemic shunt (TIPS) - direct intrahepatic portosystemic shunt (DIPS) - TIPS revision - portal hypertension - blocked TIPS
14 August 2020 (online)
Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India
- 1 Parvinian A, Bui JT, Knuttinen MG, Minocha J, Gaba RC. Transjugular intrahepatic portosystemic shunt for the treatment of medically refractory ascites. Diagn Interv Radiol 2014; 20 (01) 58-64
- 2 Petersen BD, Clark TW. Direct intrahepatic portocaval shunt. Tech Vasc Interv Radiol 2008; 11 (04) 230-234
- 3 Cura M, Cura A, Suri R, El-Merhi F, Lopera J, Kroma G. Causes of TIPS dysfunction. AJR Am J Roentgenol 2008; 191 (06) 1751-1757
- 4 Weber CN, Nadolski GJ, White SB. et al. Long-term patency and clinical analysis of expanded polytetrafluoroethylene-covered transjugular intrahepatic portosystemic shunt stent grafts. J Vasc Interv Radiol 2015; 26 (09) 1257-1265, quiz 1265
- 5 Darcy M. Evaluation and management of transjugular intrahepatic portosystemic shunts. AJR Am J Roentgenol 2012; 199 (04) 730-736 Review. Erratum in: AJR Am J Roentgenol. 2013 Jan;200(1):232. PubMed PMID: 22997362
- 6 Spiliopoulos S, Vasiniotis Kamarinos N, Konstantos C. et al. Recanalization of occluded transjugular intrahepatic portosystemic shunts using the Rösch-Uchida stiffening cannula. Cardiovasc Intervent Radiol 2018; 41 (05) 799-803
- 7 Tanaka T, Günther RW, Isfort P, Kichikawa K, Mahnken AH. Pull-through technique for recanalization of occluded portosystemic shunts (TIPS): technical note and review of the literature. Cardiovasc Intervent Radiol 2011; 34 (02) 406-412
- 8 Haskal ZJ, Ring EJ, LaBerge JM. et al. Role of parallel transjugular intrahepatic portosystemic shunts in patients with persistent portal hypertension. Radiology 1992; 185 (03) 813-817
- 9 He FL, Wang L, Yue ZD, Zhao HW, Liu FQ. Parallel transjugular intrahepatic portosystemic shunt for controlling portal hypertension complications in cirrhotic patients. World J Gastroenterol 2014; 20 (33) 11835-11839
- 10 Raissi D, Yu Q, Nisiewicz M, Krohmer S. Parallel transjugular intrahepatic portosystemic shunt with Viatorr® stents for primary TIPS insufficiency: Case series and review of literature. World J Hepatol 2019; 11 (02) 217-225
- 11 Rathod K, Popat B, Barai P, Amrapurkar D. Parallel transjugular intrahepatic portosystemic shunt (TIPS) creation in a patient with a preexisting unsalvageable occluded tips and refractory variceal bleeding. J Clin Intervent Radiol ISVIR 2017; 1: 40-42