Biliary-Venous Fistula Complicating Transjugular Intrahepatic Portosystemic Shunt Presenting With Recurrent Bacteremia, Jaundice, Anemia and Fever

Jawaid, Qaiser; Saeed, Zahid A.; Bisceglie, Adrian M. Di; Brunt, Elizabeth M.; Ramrakhiani, Sanjay; Varma, Chintalapati; Solomon, Harvey

doi:10.1046/j.1600-6135.2003.00267.x

Cited by 27 publications

(20 citation statements)

References 18 publications

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“…Most of early occlusion events with bare stents are due to the development of biliary venous fistula, caused by the puncture with Cola Pinto needle or occurring during stent expansion. This kind of occlusion events are less common with graft stents because biliary injury is covered by the graft stent, and prevent from the biliary venous fistula development (32,33). Late TIPS stenoses, which may lead to occlusion, are mostly caused by intimal hyperplasia (34,35).…”

Section: Discussionmentioning

confidence: 99%

Persistence of gastric or esophageal varices on final angiography increases transjugular intrahepatic portosystemic shunt revision rate after polytetrafluoroethylene-covered stent shunt creation

Moulin¹,

Chevallier²,

Abdulmalak³

et al. 2018

Quant. Imaging Med. Surg.

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Background: To assess the association between final polytetrafluoroethylene (PTFE)-covered stent transjugular intrahepatic portosystemic shunt (TIPS) angiographic parameters and free shunt revision survey. Results: Mean follow-up was 455 days. Thirteen (19.4%) patients had shunt revision. Significant free shunt revision survey difference was found between post-procedural angiographic persistent varices group and the group without varices (P=0.0001). Shunt revision rate at 3, 12 and 24 months was respectively 13%, 29%, and 39% in the group with varices versus 0%, 2.7% and 2.7% in the group without. No difference was found between groups for angles A, B, C and distance D.Conclusions: Persistence of gastric or esophageal varices on final trans-TIPS angiography increases TIPS revision rate after PTFE-covered stent shunt creation whereas geometric parameters have no influence.

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Section: Discussionmentioning

confidence: 99%

Persistence of gastric or esophageal varices on final angiography increases transjugular intrahepatic portosystemic shunt revision rate after polytetrafluoroethylene-covered stent shunt creation

Moulin¹,

Chevallier²,

Abdulmalak³

et al. 2018

Quant. Imaging Med. Surg.

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“…Anemia, hyperbilirrubinemia and systemic sepsis are the most common clinical manifestations 5,7,8,15 . Total bilirrubin levels have been reported to range between 5 and 8 mg/dl, without significant increase in transaminases and alkaline phosphatase.…”

Section: Discussionmentioning

confidence: 99%

“…The most frequent complications related to this procedure are: hepatic encephalopathy, bleeding, deterioration of liver function and occlusion of the stent 11 . Bilhemia, defined as the passage of bile into the bloodstream through a bile duct-venous fistula, is rarely observed but it has been reported following TIPS procedure 5,7,13 , liver biopsy 17 , liver trauma 4 and transhepatic percutaneous catheter placement 12 . The clinical scenario in these cases is associated with recurrent bacteremia, fever, jaundice and anemia.…”

Section: Introductionmentioning

confidence: 99%

Hemobilia após colocação de anastomose portossistêmica intra-hepática transjugular (TIPS): transplante hepático de resgate - relato de caso

Kruel

Guimarães

Chedid

et al. 2013

ABCD, arq. bras. cir. dig.

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“…The most commonly reported complications of TIPS include hepatic encephalopathy (10%‐49%), shunt stenosis or occlusion (13%‐15% with covered stents and 18%‐78% with bare stents), sepsis (2%‐10%), and stent migration to the portal vein or the right atrium (8%‐20%) 1, 4. Biliary complications from TIPS are considered rare, and only a few cases have been described 5‐12. We report an unusual complication: the misplacement of a TIPS into the common hepatic duct (CHD).…”

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confidence: 95%

Malpositioned transjugular intrahepatic portosystemic shunt in the common hepatic duct leading to biliary obstruction and liver transplantation

et al. 2011

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For more than 20 years, placement of a transjugular intrahepatic portosystemic shunt (TIPS) has been a first-line treatment option for portal hypertension in patients with decompensated cirrhosis. It has been used in the management of complications such as variceal bleeding and refractory ascites. [1][2][3] The most commonly reported complications of TIPS include hepatic encephalopathy (10%-49%), shunt stenosis or occlusion (13%-15% with covered stents and 18%-78% with bare stents), sepsis (2%-10%), and stent migration to the portal vein or the right atrium (8%-20%). 1,4 Biliary complications from TIPS are considered rare, and only a few cases have been described. [5][6][7][8][9][10][11][12] We report an unusual complication: the misplacement of a TIPS into the common hepatic duct (CHD). CASE REPORTA 59-year-old Hispanic man with hepatitis C cirrhosis and portal hypertension presented to an outside hospital with hematemesis. His initial laboratory results included a total bilirubin (Tb) level of 0.8 mg/dL, a serum creatinine (SCr) level of 0.7 mg/dL, and an international normalized ratio (INR) of 1.2. Upper endoscopy revealed bleeding esophageal varices, which were banded. However, the bleeding continued, and a TIPS was placed. An 80 Â 10-mm metallic stent was deployed, and a portogram at the completion of the procedure noted a well-positioned and patent shunt.However, Doppler ultrasound on the following morning demonstrated minimal flow in the shunt. A followup portogram noted that the TIPS was thrombosed, and a TIPS revision was unsuccessful.The patient became progressively more jaundiced, and endoscopic retrograde cholangiopancreatography (ERCP) showed a biliary obstruction at the level of the proximal CHD. Percutaneous transhepatic cholangiography (PTC) was then performed with the placement of bilateral biliary drainage catheters, and the patient was transferred to our facility for further management.At presentation to our center, the patient had a Tb level of 23.9 mg/dL, a SCr level of 1.2 mg/dL, and an INR of 1.4. A computed tomography scan was suspicious for a malpositioned TIPS in the CHD (Fig. 1), and thromboses of the right, left, and main portal veins were noted. Initial contrast studies through the PTC catheters confirmed obstruction of the right hepatic duct (RHD) and left hepatic duct (LHD) with the TIPS seen at its confluence. Delayed images showed contrast tracking around the lateral edges of the shunt, which filled the common bile duct (CBD) distally (Fig. 2). Malposition of the TIPS causing nearly complete obstruction of the CHD was confirmed. The patient's condition deteriorated (Tb level ¼ 24.1 mg/ dL, SCr level ¼ 1.7 mg/dL, and INR ¼ 2.2), and he was evaluated and listed for liver transplantation with a Model for End-Stage Liver Disease score of 32. Ten Abbreviations: CBD, common bile duct; CHD, common hepatic duct; ERCP, endoscopic retrograde cholangiopancreatography; INR, international normalized ratio; LHD, left hepatic duct; PTC, percutaneous transhepatic cholangiography; RHD, right hepa...

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Biliary-Venous Fistula Complicating Transjugular Intrahepatic Portosystemic Shunt Presenting With Recurrent Bacteremia, Jaundice, Anemia and Fever

Cited by 27 publications

References 18 publications

Persistence of gastric or esophageal varices on final angiography increases transjugular intrahepatic portosystemic shunt revision rate after polytetrafluoroethylene-covered stent shunt creation

Persistence of gastric or esophageal varices on final angiography increases transjugular intrahepatic portosystemic shunt revision rate after polytetrafluoroethylene-covered stent shunt creation

Hemobilia após colocação de anastomose portossistêmica intra-hepática transjugular (TIPS): transplante hepático de resgate - relato de caso

Malpositioned transjugular intrahepatic portosystemic shunt in the common hepatic duct leading to biliary obstruction and liver transplantation

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