title: Acute TIPS occlusion due to iatrogenic arteriovenous shunt in a cirrhotic patient with total portal vein thrombosis.
abstract: A 69-year-old man with portal hypertension was admitted with decompensated alcoholic cirrhosis and diuretic resistant ascites. Ultrasound revealed partial portal thrombosis. Due to diuretic intolerance, transjugular intrahepatic portosystemic shunt (TIPS) was decided during which a hepatic arterial branch was inadvertently catheterized. Finally, TIPS was created, but the patient continued gaining weight. Color-Doppler ultrasonography (CDUS) showed upper stent part patency with absence of flow in lower stent portion. Twenty-five days later, the patient presented melena. Endoscopy revealed blood emerging from the Vater papilla. Hepatic angiography revealed arteriovenous shunt between a hepatic arterial branch and the proximal part of the TIPS shunt. Covered stent placement restored sufficient TIPS flow. The patient deteriorated and died 1 month later. We found out that our major technical drawback was that we did not inject a small amount of contrast after puncturing the supposed portal vein, in order to confirm correct position of the needle.
authors.affiliation: University Hospital of Heraklion Crete , Heraklion, Crete , Greece.
authors.forename: Adam
authors.initials: A
authors.lastname: Hatzidakis
authors.affiliation: University Hospital of Heraklion Crete , Heraklion, Crete , Greece.
authors.forename: Elias
authors.initials: E
authors.lastname: Kouroumalis
authors.affiliation: University Hospital of Heraklion Crete , Heraklion, Crete , Greece.
authors.forename: Elias
authors.initials: E
authors.lastname: Kehagias
authors.affiliation: University Hospital of Heraklion Crete , Heraklion, Crete , Greece.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Digenakis
authors.affiliation: University Hospital of Heraklion Crete , Heraklion, Crete , Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Samonakis
authors.affiliation: University Hospital of Heraklion Crete , Heraklion, Crete , Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tsetis
keywords: TIPS; arteriovenous shunt; complications; interventional radiology; portal vein thrombosis