Korean J Radiol.  2010 Aug;11(4):469-471. 10.3348/kjr.2010.11.4.469.

Recanalization of an Occluded Intrahepatic Portosystemic Covered Stent via the Percutaneous Transhepatic Approach

• Chan CY
• Liang PC

• KMID: 984901
• DOI: http://doi.org/10.3348/kjr.2010.11.4.469

Abstract

A 41-year-old woman with liver cirrhosis had recurrent portal hypertension and bleeding from esophageal varices due to complete occlusion of a previously inserted transjugular intrahepatic portosystemic shunt stent. Because recanalization of the stent by the transjugular approach was unsuccessful, ultrasound-guided entry to the splenic vein and portal vein was used. After catheter-directed intrathrombus thrombolysis, successful opening of the stent was achieved and a stent was placed. We herein report a rare case in which thrombolysis and recanalization of a TIPS stent were performed via a percutaneous transhepatic approach.

Keyword

Transjugular intrahepatic portosystemic shunt; Percutaneous transsplenic recanalization; Thrombolysis; Portal hypertension; Thrombosis

MeSH Terms

Adult
Esophageal and Gastric Varices/etiology/*surgery
Female
Humans
Hypertension, Portal/etiology/*surgery
Liver Cirrhosis/complications
Portasystemic Shunt, Transjugular Intrahepatic/*adverse effects
Reoperation
Stents/*adverse effects
Vascular Patency

Figure

• 

  Fig. 1 Recanalization of occluded intrahepatic portosystemic covered stent. A. Direct portography performed from transsplenic catheter showed occluded intrahepatic portosystemic covered stent. Superior mesenteric vein filled in retrograde direction and gastric collaterals were also observed. B. With advancing catheter into covered stent, incomplete recanalization was obvious with residual thrombosis and outflow hepatic venous occlusion. C. Wire was successfully negotiated through hepatic vein into caval vein. D. New stent placed through covered stent (arrow) and hepatic vein into caval vein. E. Portography at completion of procedure showed that shunt is now patent. F. Coil embolization of transplenic tract upon removal of final sheath. Subcapsular lining of spleen (arrow) and tip of sheath are observed.

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