Mechanical thrombectomy of acute thrombosis in transjugular intrahepatic portosystemic shunts.
OBJECTIVE
To evaluate the feasibility of mechanical thrombectomy with the use of the Amplatz thrombectomy device (ATD) in restoring patency to acutely thrombosed stent-shunts after transjugular intrahepatic portosystemic shunt (TIPS) placement.


METHODS
Mechanical thrombectomy with the ATD was performed in 10 consecutive patients with angiographically documented complete thrombosis of the stent-shunt (mean +/- SD, 6.6 +/- 3.4 cm), which occurred an average of 2.8 months (range, 0-11 months) after the TIPS procedure.


RESULTS
In all patients, immediate restoration of patency of the stent-shunt was achieved after thrombectomy alone (n = 1), thrombectomy plus percutaneous transluminal angioplasty (PTA; n = 4), and thrombectomy, PTA, and stenting (n = 5). The mean activation time of the ATD was 253 +/- 43 seconds. The pressure gradient for portal decompression decreased from 23 +/- 6 mmHg before to 11 +/- 3 mmHg after the procedure. The primary patency rate was 80% at 3 months and 60% at 11 months.


CONCLUSIONS
Mechanical thrombectomy with the ATD in acutely thrombosed TIPS is technically feasible. Mechanical thrombectomy is a potential alternative to thrombolysis.
Müller-Hülsbeck
S
S
Department of Radiology, Christian-Albrechts-University of Kiel, Germany. muehue@rad.uni-kiel.de
Höpfner
M
M
Hilbert
C
C
Krämer-Hansen
H
H
Heller
M
M
D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D004867:Equipment Design; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011475:Prosthesis Failure; D017131:Thrombectomy / Q000295:instrumentation*; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome