Transcaval transjugular intrahepatic portosystemic shunt: preliminary clinical results.
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.


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.


CONCLUSIONS
In patients with unusual anatomy between the hepatic veins and portal bifurcation, and inaccessible or inadequate hepatic veins, transcaval TIPS creation is feasible.
Lee
Kwang-Hun
KH
Department of Diagnostic Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
Lee
Do-Yun
DY
Won
Jong-Yoon
JY
Park
Sang Joon
SJ
Kim
Jae Kyu
JK
Yoon
Woong
W
D000328:Adult; D000368:Aged; D006502:Budd-Chiari Syndrome / Q000150:complications; D004932:Esophageal and Gastric Varices / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000601:surgery*; D006503:Hepatic Veins / Q000033:anatomy & histology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000033:anatomy & histology; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods*; D014682:Vena Cava, Inferior