[Portal vein thrombosis after occlusion of a transjugular intrahepatic portosystemic stent-shunt (TIPSS). Shunt dilatation with subsequent local and systemic thrombolysis].
METHODS
A transjugular intrahepatic portosystemic stent shunt (TIPSS) had been implanted to lower the portal hypertension in a 56-year-old man with alcoholic liver cirrhosis and several bleedings from fundal varices. A shunt revision with dilatation became necessary one year later. Recently the patient had gained 8 kg in weight in 3 weeks and his abdomen had become distended. The patient's general condition (height 179 cm, weight 82.9 kg) was clearly reduced. He had marked ascites, the liver was enlarged to 17 cm below the costal margin and the right lung base was dull on percussion.


METHODS
Abdominal sonography detected marked ascites and liver cirrhosis with splenomegaly. Duplex sonography failed to demonstrate any flow in the shunt, indicating its occlusion.


METHODS
At retrograde dilatation of the stent a fresh thrombosis was noted in the right branch of the portal vein and a partial one in the main trunk. Recanalization was achieved locally 10 mg and systemically 100 mg recombinant tissue plasminogen activator (r-tPA). Hepatic vein pressure measurements before and after the thrombolysis demonstrated a significantly lower hepatic venous occlusion gradient, and the portal hypertension had been reduced by about 45%. The ascites gradually resolved.


CONCLUSIONS
Combined local and systemic thrombolysis was successful in recanalizing portal vein thrombosis after TIPSS.
Gabler
R
R
III. Medizinische Klinik, Zentralklinikum Augsburg.
Barnert
J
J
Bohndorf
K
K
Eberl
T
T
Wienbeck
M
M
D001201:Ascites / Q000000981:diagnostic imaging / Q000209:etiology; D004932:Esophageal and Gastric Varices / Q000150:complications; D006471:Gastrointestinal Hemorrhage / Q000150:complications; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000601:surgery; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects*; D011994:Recombinant Proteins / Q000627:therapeutic use; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000188:drug therapy / Q000209:etiology*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014463:Ultrasonography
D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator
Pfortaderthrombose nach Verschluss eines transjugulären intrahepatischen portosystemischen Stent-Shunts (TIPSS). Shunt-Dilatation mit anschliessender lokaler und systemischer Thrombolyse.