Transjugular intrahepatic portosystemic shunt (TIPS) creation is most commonly performed for patients with refractory ascites or variceal hemorrhage. While TIPS have also been created prior to planned abdominal operation to decrease morbidity related to portal hypertension, there are limited data supporting its effectiveness in that indication. The goal of this study was to determine if preoperative TIPS creation allows for successful abdominal operation with limited morbidity. Methods: A retrospective review of records of 22 consecutive patients who underwent TIPS creation for the specific indication of improving surgical candidacy, between 2011 and 2016, was performed. Clinical and serologic data were obtained for 21 patients (one patient was excluded since she was completely lost to follow up after TIPS creation). The primary endpoint was whether patients underwent planned abdominal operation following TIPS. Operative outcomes and reasons that patients failed to undergo planned operation were examined as secondary endpoints. The mean age was 56.4 ± 8.8 years, and the mean Child-Pugh and Model for End-Stage Liver Disease (MELD) scores were 7.2 ± 1.5 and 11.9 ± 4.3, respectively. Results: TIPS creation was performed in all 21 patients with a thirty-day mortality rate of 9.5%. Eleven patients (52.4%) subsequently underwent abdominal operation after which the thirty-day postoperative mortality rate was 0%. One patient (9.1%) had major perioperative morbidity related to portal hypertension and presented with surgical wound dehiscence and infection requiring drain placement and antibiotic therapy. Conclusions: In this population, TIPS allowed successful abdominal operation in the majority of patients, with thirty-day TIPS mortality of 9.5%, no perioperative mortality, and 9.1% major postoperative morbidity attributable to portal hypertension.

Several studies have analyzed the efficacy of AngioVac for percutaneous intracardiac vegetectomy, but impact on surgical candidacy or clinical efficacy for infectious endocarditis (IE) is currently unknown. This is a single-arm, retrospective study on IE vegetectomy with impact on surgical risk scores. Analysis included 32 patients who underwent AngioVac vegetectomy for right heart IE at a single institution. The primary endpoint was improvement in the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) scores. Secondary endpoints included technical success, improved leukocytosis, procedural safety, 30-day mortality, and 60-day mortality. Findings demonstrate 90.6% (n = 29) technically successful debulking. There was improvement in mean NSQIP scores from 34.6 to 27.9 ( P = .007). Zero cases of 30-day all-cause mortality. One patient experienced a major post-procedural complication of pneumothorax, a Class D Adverse Event. 20.5% (n = 5) of valvular vegetation patients went on to have surgical tricuspid valve repair. All indwelling intracardiac devices were removed. Findings suggest that percutaneous vegetectomy improves surgical candidacy, as measured by ACS NSQIP scores, in patients with IE and right heart vegetations and is associated with low complication rates.

Purpose: TIPS creation is typically reserved for patients with refractory ascites or variceal hemorrhage. While TIPS have also been created prior to planned abdominal operation to decrease morbidity related to portal hypertension, there is little in the literature supporting its effectiveness in that indication. The goal of this study was to determine if preoperative TIPS creation allows successful abdominal operation and improves outcomes. Materials: A retrospective review of records of 22 consecutive patients who underwent TIPS creation for the specific indication of improving surgical candidacy, between 2011 and 2016, was performed. Clinical and serologic data were obtained for 21 patients because one patient was lost to follow up after TIPS creation. The primary endpoint was whether patients underwent planned abdominal operation following TIPS. Operative outcomes and reasons that patients failed to undergo planned operation were examined as secondary endpoints. The mean age was 56.4±8.8 years, and the mean Child-Pugh and Model for End-Stage Liver Disease (MELD) scores were 7.2±1.5 and 11.9±4.3, respectively. Results: TIPS creation was technically successful in all 21 patients with a thirty-day mortality rate of 9.5%; one patient died due to a transfusion reaction and another died of severe sepsis. Eleven patients (52.4%) subsequently underwent planned abdominal operation and the thirty-day postoperative mortality rate was 0%. One of these 11 patients (9.1%) had major postoperative morbidity, with recurrent ascites leading to delayed wound healing and the development of a surgical site infection requiring drain placement. Reasons for failure to proceed to abdominal operation after TIPS included resolution of hernia due to reduction of ascites, development of malignancy, encephalopathy requiring TIPS revision, transportation issues, and death. In three cases the reason for cancellation of the abdominal operation was unknown. Conclusions: In this population, TIPS allowed successful abdominal operation in the majority of patients, with thirty-day TIPS mortality of 9.5%, no perioperative mortality, and 9.1% major postoperative morbidity.

Coronary artery perforation is a rare but serious complication of percutaneous coronary intervention. This case report describes a patient with Grade III perforation of the left anterior descending coronary artery who underwent placement of a peripheral arterial stent graft due to persistent contrast extravasation refractory to conventional coronary stent graft placement and balloon tamponade.