title: Pull-through technique for recanalization of occluded portosystemic shunts (TIPS): technical note and review of the literature.
abstract: Transjugular intrahepatic portosystemic shunt (TIPS) dysfunction is an important problem after creation of shunts. Most commonly, TIPS recanalization is performed via the jugular vein approach. Occasionally it is difficult to cross the occlusion. We describe a hybrid technique for TIPS revision via a direct transhepatic access combined with a transjugular approach. In two cases, bare metal stents or polytetrafluoroethylene (PTFE)-covered stent grafts had been placed in TIPS tract previously, and they were completely obstructed. The tracts were inaccessible via the jugular vein route alone. In each case, after fluoroscopy or computed tomography-guided transhepatic puncture of the stented segment of the TIPS, a wire was threaded through the shunt and snared into the right jugular vein. The TIPS was revised by balloon angioplasty and additional in-stent placement of PTFE-covered stent grafts. The patients were discharged without any complications. Doppler sonography 6 weeks after TIPS revision confirmed patency in the TIPS tract and the disappearance of ascites. We conclude that this technique is feasible and useful, even in patients with previous PTFE-covered stent graft placement.
authors.affiliation: Department of Diagnostic Radiology, Aachen University Hospital, RWTH Aachen University, Aachen, Germany. toshihir@bf6.so-net.ne.jp
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Tanaka
authors.forename: Rolf W
authors.initials: RW
authors.lastname: Günther
authors.forename: Peter
authors.initials: P
authors.lastname: Isfort
authors.forename: Kimihiko
authors.initials: K
authors.lastname: Kichikawa
authors.forename: Andreas H
authors.initials: AH
authors.lastname: Mahnken
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011475:Prosthesis Failure; D012086:Reoperation; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D014654:Vascular Patency