title: Transjugular insertion of biliary stents (TIBS) in two patients with malignant obstruction, ascites, and coagulopathy.
abstract: Two patients with pancreatic malignancies presented with biliary obstruction which could not be treated from an endoscopic approach. Standard transhepatic biliary drainage was relatively contraindicated because of moderate ascites and coagulopathy related to underlying liver disease. In one patient, a transjugular, transvenous approach was used to deliver a Wallstent endoprosthesis across the distal common bile duct obstruction in a single step procedure. In the second case, a previously placed biliary Wallstent was revised with an additional stent from a similar approach. Transjugular biliary catheterization offers a valuable alternative approach for primary stent placement or revision in patients with contraindication to standard transhepatic drainage.
authors.affiliation: Department of Interventional Radiology, Hospital of the University of Pennsylvania, Philadelphia, 19104, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Amygdalos
authors.forename: Z J
authors.initials: ZJ
authors.lastname: Haskal
authors.forename: C
authors.initials: C
authors.lastname: Cope
authors.forename: S L
authors.initials: SL
authors.lastname: Kadish
authors.forename: W B
authors.initials: WB
authors.lastname: Long
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000628:therapy; D001201:Ascites / Q000000981:diagnostic imaging / Q000628:therapy*; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000628:therapy; D002404:Catheterization / Q000295:instrumentation; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D001651:Cholestasis, Extrahepatic / Q000000981:diagnostic imaging / Q000628:therapy*; D003138:Common Bile Duct Neoplasms / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006801:Humans; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging; D008641:Mesenteric Vascular Occlusion / Q000000981:diagnostic imaging / Q000628:therapy*; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000628:therapy*; D011169:Portal Vein / Q000000981:diagnostic imaging; D011859:Radiography; D015607:Stents; D013396:Suction / Q000295:instrumentation; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000628:therapy*