J Korean Radiol Soc.  1997 Mar;36(3):405-410.

Revision of Transjugular Intrahepatic Portosystemic Shunt (TIPS)

• Ryeom HK
• Kim YJ

Abstract

PURPOSE
To evaluate the feasibility and efficacy of revision of the transjugular intrahepatic portosystemic shunt (TIPS).
MATERIALS AND METHODS
Sixteen malfunctioning TIPS (10 occlusions, 6 stenoses) in 14 patients of 103 patients (117 procedures) were revised. Fifteen patients underwent revision to control recurrent variceal bleeding after TIPS and one to restore severely stenotic TIPS found on portal venogram obtained during transarterial chemoembolization of a hepatocellular carcinoma. One patient underwent three revisions. The time intervals between initial TIPS placement and revisional procedures varied between four and 43 months (mean, 17.6 months). Nine occlusions and four stenoses were treated with an additional stent placed in a parallel or overlapping fashion with transjugular approaches. Two stenoses and one acute occlusion were treated with balloon dilatation involving transfemoral approaches.
RESULTS
In patients with complete occlusion of TIPS, the sites of occlusion were all within the stent, with or without associated stenosis of the hepatic vein. In five of six patients, with TIPS stenosis, however, the stenoses were located at the hepatic vein just distal to the stents, rather than within the stents. The procedures for revision were in all cases technically feasible and hemodynamically successful. No significant procedure-related complications were encountered.
CONCLUSION
The revision of TIPS is a safe and effective method in cases of its partial or complete occlusion.

Keyword

Hypertension, portal; Interventional procedures, complications; Shunts, portosystemic

MeSH Terms

Carcinoma, Hepatocellular
Constriction, Pathologic
Dilatation
Esophageal and Gastric Varices
Hepatic Veins
Humans
Hypertension, Portal
Portasystemic Shunt, Surgical*
Stents