title: Segmental liver ischemia/infarction after elective transjugular intrahepatic portosystemic shunt creation: clinical outcomes in 10 patients.
abstract: OBJECTIVE
  To determine the clinical significance and potential mechanisms of segmental liver ischemia and infarction following elective creation of a transjugular intrahepatic portosystemic shunt (TIPS).
  
  
  METHODS
  A retrospective review of 374 elective TIPS creations between March 2006 and September 2014 was performed, yielding 77 contrast-enhanced scans for review. Patients with imaging evidence of segmental perfusion defects were identified. Model for End-stage Liver Disease scores, liver volume, and percentage of liver ischemia/infarct were calculated. Clinical outcomes after TIPS creation were reviewed.
  
  
  RESULTS
  Ten patients showed segmental liver ischemia/infarction on contrast-enhanced imaging after elective TIPS creation. Associated imaging findings included thrombosis of the posterior division (n = 7) and anterior division (n = 3) of the right portal vein (PV). The right hepatic vein was thrombosed in 5 patients, as was the middle hepatic vein in 3 and the left hepatic vein in 1. One patient had acute thrombosis of the shunt and main PV. Three patients developed acute liver failure: 2 died within 30 days and 1 required emergent liver transplantation. One patient died of acute renal failure 20 days after TIPS creation. A large infarct in a transplant recipient resulted in biloma formation. Five patients survived without additional interventions with follow-up times ranging from 3 months to 5 years.
  
  
  CONCLUSIONS
  Segmental perfusion defects are not an uncommon imaging finding after elective TIPS creation. Segmental ischemia was associated with thrombosis of major branches of the PVs and often of the hepatic veins. Clinical outcomes varied significantly, from transient problems to acute liver failure with high mortality rates.
authors: Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229.. Electronic address: lopera@uthscsa.edu.
authors: Jorge E
authors: JE
authors: Lopera
authors: Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229.
authors: Venkata
authors: V
authors: Katabathina
authors: Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229.
authors: Brian
authors: B
authors: Bosworth
authors: Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229.
authors: Deepak
authors: D
authors: Garg
authors: Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229.
authors: Ghazwan
authors: G
authors: Kroma
authors: Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229.
authors: Andres
authors: A
authors: Garza-Berlanga
authors: Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229.
authors: Rajeev
authors: R
authors: Suri
authors: Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229.
authors: Michael
authors: M
authors: Wholey
mesh_terms: D000328:Adult; D000368:Aged; D017558:Elective Surgical Procedures; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D007238:Infarction / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D008099:Liver / Q000098:blood supply*; D008107:Liver Diseases / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D055420:Perfusion Imaging; D010690:Phlebography / Q000379:methods; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects* / Q000401:mortality; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013781:Texas; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy