Cardiac Perforation and Tamponade During Transjugular Intrahepatic Portosystemic Shunt Placement

McCowan, Timothy C.; Hummel, Michael M.; Schmucker, Tracey; Goertzen, Timothy C.; Culp, William C.; Habbe, Thomas G.

doi:10.1007/s002700010072

Cited by 7 publications

(3 citation statements)

References 8 publications

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“…McCowan et al (21) reported a case of cardiac perforation and tamponade during TIPS placement. The heart was, presumably, perforated by instrumentation during the initial phase of the procedure, at which point manipulation to gain suitable access to the hepatic vein was performed.…”

Section: Discussionmentioning

confidence: 99%

Transcaval TIPS in Patients with Failed Revision of Occluded Previous TIPS

et al. 2001

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ObjectiveTo determine the feasibility of transcaval transjugular intrahepatic portosystemic shunt (TIPS) in patients with occluded previous TIPS.Materials and MethodsBetween February 1996 and December 2000 we performed five transcaval TIPS procedures in four patients with recurrent gastric cardiac variceal bleeding. All four had occluded TIPS, which was between the hepatic and portal vein. The interval between initial TIPS placement and revisional procedures with transcaval TIPS varied between three and 31 months; one patient underwent transcaval TIPS twice, with a 31-month interval. After revision of the occluded shunt failed, direct cavoportal puncture at the retrohepatic segment of the IVC was attempted.ResultsTranscaval TIPS placement was technically successful in all cases. In three, tractography revealed slight leakage of contrast materials into hepatic subcapsular or subdiaphragmatic pericaval space. There was no evidence of propagation of extravasated contrast materials through the retroperitoneal space or spillage into the peritoneal space. After the tract was dilated by a bare stent, no patient experienced trans-stent bleeding and no serious procedure-related complications occurred. After successful shunt creation, variceal bleeding ceased in all patients.ConclusionTranscaval TIPS placement is an effective and safe alternative treatment in patients with occluded previous TIPS and no hepatic veins suitable for new TIPS.

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Section: Discussionmentioning

confidence: 99%

Transcaval TIPS in Patients with Failed Revision of Occluded Previous TIPS

et al. 2001

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“…Cardiac perforation is exceedingly rare but has been reported and can be potentially fatal. 4 If getting a wire into the IVC is difficult, a second “buddy” wire can be placed in the IVC and be left as a security wire in case the IVC access is lost when trying to select the hepatic vein (HV).…”

Section: Procedural Complicationsmentioning

confidence: 99%

A Comprehensive Review of Transjugular Intrahepatic Portosystemic Shunt–Related Complications

Lopera

2023

Semin intervent Radiol

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Transjugular intrahepatic portosystemic shunt (TIPS) is one of the most technically complex procedures in interventional radiology, the need to connect two veins with variable anatomy, located in two different planes in hard and many times small cirrhotic livers using a needle, can be quite challenging. Despite more than 30 years of performing TIPS, the complex hemodynamics of the portal system are not fully understood, and sometimes unpredictable alterations of the portal flow can lead to serious unexpected complications. The best strategies to prevent TIPS complications are optimal patient selection, meticulous technique, operator experience, and immediate correction of identified adverse events. The purpose of this article is to review the technical complications with TIPS, the unique complications related to the use of stent grafts, and the late complications after the procedure, with emphasis on ways to prevent and treat them.

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“…The procedure is classically performed by interventional radiologists whereby the portal vein is accessed via the right‐side of the heart followed by creation of a low‐resistance channel between the portal vein and hepatic vein. Unfortunately, TIPS has been associated with cardiac arrhythmias as well as cardiac perforation complicated by tamponade . EUS‐guided creation of an IPSS has been described in animal models with placement of uncovered metal biliary stents advanced over a guidewire under sonographic and fluoroscopic guidance .…”

Section: Therapeutic and Novel Use Of Eusmentioning

confidence: 99%

Endoscopic ultrasound and the liver: current applications and beyond

Shah

Baron

2018

J Hepato Biliary Pancreat

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The diagnosis and management of many gastrointestinal conditions has been augmented by the development of endoscopic ultrasound. Its role in the diagnosis and management of liver disease has been somewhat limited, but with the rapid development of therapeutic advancements it has quickly emerged as a useful tool in the management of complex hepatic conditions. This includes its use in the management of complications of portal hypertension as well as its use in liver lesions and cancer. In this paper, we review case studies, case series and trials for hepatic applications of endoscopic ultrasound to provide an overview of its utilization in this field and demonstrating its more novel applications for future use.

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Cardiac Perforation and Tamponade During Transjugular Intrahepatic Portosystemic Shunt Placement

Cited by 7 publications

References 8 publications

Transcaval TIPS in Patients with Failed Revision of Occluded Previous TIPS

Transcaval TIPS in Patients with Failed Revision of Occluded Previous TIPS

A Comprehensive Review of Transjugular Intrahepatic Portosystemic Shunt–Related Complications

Endoscopic ultrasound and the liver: current applications and beyond

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