Mechanical hemolysis after transjugular intrahepatic portosystemic shunt can occur with covered stent

Dumortier, Jérôme; Menassel, Badis; Benech, Nicolas; Bertrand, G; Valette, Pierre-Jean

doi:10.1016/j.clinre.2019.09.006

Cited by 3 publications

(3 citation statements)

References 6 publications

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“…In those patients, hemolysis is mostly transient and appears to be less frequent than in our patients [32]. However, hemolysis is less likely in newer covered TIPS [33], so the bilirubinemia may most likely be attributable to a combination of reduced liver perfusion via shunting and hemolysis owing to hypersplenism. Portal hyperflow in our HSS patients with massively enlarged spleens may contribute to the higher degree of hemolysis.…”

Section: Discussionmentioning

confidence: 55%

TIPS and splenorenal shunt for complications of portal hypertension in chronic hepatosplenic schistosomiasis–A case series and review of the literature

et al. 2021

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Background Transjugular intrahepatic portosystemic shunt (TIPS) and shunt surgery are established treatment options for portal hypertension, but have not been systematically evaluated in patients with portal hypertension due to hepatosplenic schistosomiasis (HSS), one of the neglected tropical diseases with major impact on morbidity and mortality in endemic areas. Methods In this retrospective case study, patients with chronic portal hypertension due to schistosomiasis treated with those therapeutic approaches in four tertiary referral hospitals in Germany and Italy between 2012 and 2020 were included. We have summarized pre-interventional clinical data, indication, technical aspects of the interventions and clinical outcome. Findings Overall, 13 patients with confirmed HSS were included. 11 patients received TIPS for primary or secondary prophylaxis of variceal bleeding due to advanced portal hypertension and failure of conservative management. In two patients with contraindications for TIPS or technically unsuccessful TIPS procedure, proximal splenorenal shunt surgery in combination with splenectomy was conducted. During follow-up (mean follow-up 23 months, cumulative follow-up time 31 patient years) no bleeding events were documented. In five patients, moderate and transient episodes of overt hepatic encephalopathy were observed. In one patient each, liver failure, portal vein thrombosis and catheter associated sepsis occurred after TIPS insertion. All complications were well manageable and had favorable outcomes. Conclusions TIPS implantation and shunt surgery are safe and effective treatment options for patients with advanced HSS and sequelae of portal hypertension in experienced centers, but require careful patient selection.

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Section: Discussionmentioning

confidence: 55%

TIPS and splenorenal shunt for complications of portal hypertension in chronic hepatosplenic schistosomiasis–A case series and review of the literature

et al. 2021

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“…Our case highlights a time-course that fits with TIPS-induced hemolysis, considered a rare phenomenon with covered stents. To our knowledge there are only a handful of case reports demonstrating post-TIPS hemolysis with Viatorr stents [ 4 – 6 ]. Our case is unique in that this patient was tolerating a TIPS covered stent graft without evidence of hemolytic anemia but following revision, developed evidence of hemolysis.…”

Section: Discussionmentioning

confidence: 99%

Transjugular intrahepatic portosystemic shunt-induced hemolysis in a non-cirrhotic patient: a case report

et al. 2023

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Background In the 1990s, transjugular intrahepatic portosystemic shunts (TIPS) were performed using bare metal stents, and stent-induced hemolysis was a complication noted in 10% of patients. This was due to the mechanical stress created by turbulent flow from the uncovered interstices. Polytetrafluoroethylene (PTFE) stents came into regular use in the early 2000s becoming the standard equipment for TIPS placements, which are predominately covered. Due to this, stent-induced hemolysis has become a rare phenomenon. Case presentation We describe a case of TIPS-induced hemolysis in a 53-years-old Caucasian female patient without cirrhosis. The patient had a history of heterozygous factor 5 Leiden mutation and abnormal lupus anticoagulant profile with development of a portal vein thrombus. She had undergone previous TIPS placement complicated by a TIPS thrombosis 3 years after initial placement requiring venoplasty and extension of the stent. Within one month, the patient developed hemolytic anemia with extensive evaluation that did not yield an alternative cause. Due to temporal association and clinical symptoms, the hemolytic anemia was attributed to the recent TIPS revision. Conclusion This particular case of TIPS-induced hemolysis in a patient who does not have cirrhosis has not been previously described in the literature. Our case highlights that TIPS-induced hemolysis should be considered in anyone who could have potential underlying red blood cell dysfunction, not just those with cirrhosis. Further, the case demonstrates an important point that mild hemolysis (i.e., not requiring blood transfusion) can likely be managed conservatively, without stent removal.

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“…However, according to Quality Improvement Guidelines for TIPS ( 6 ), stent malposition, radiation skin burn, liver infarction and hepatic artery injury are also major complications after TIPS. Besides, other complications such as cardiac perforation due to stent embolization ( 23 ), endotipsitis-persistent infection of TIPS stent ( 24 ), and mechanical hemolysis ( 25 ) were also not observed.…”

Section: Discussionmentioning

confidence: 99%

Covered TIPS Procedure-Related Major Complications: Incidence, Management and Outcome From a Single Center

Yin

Zhang

et al. 2022

Front. Med.

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Background and ObjectiveTransjugular intrahepatic portosystemic shunt (TIPS) is a well-established procedure for treating complications of portal hypertension. Due to the complexity of anatomy and difficulty of the puncture technique, the procedure itself might brought potential complications, such as puncture failure, bleeding, infection, and, rarely, death. The aim of this study is to explore the incidence, management, and outcome of TIPS procedure-related major complications using covered stents.MethodsPatients who underwent TIPS implantation from January 2015 to December 2020 were recruited retrospectively. Major complications after TIPS were screened and analyzed.ResultsNine hundred and forty-eight patients underwent the TIPS procedure with 95.1% (n = 902) technical success in our department. TIPS procedure-related major complications occurred in 30 (3.2%) patients, including hemobilia (n = 13; 1.37%), hemoperitoneum (n = 7; 0.74%), accelerated liver failure (n = 6; 0.63%), and rapidly progressive organ failure (n = 4; 0.42%). Among them, 8 patients died because of hemobilia (n = 1), accelerated liver failure (n = 4), and rapidly progressive organ failure (n = 3).ConclusionThe incidence of major complications related to TIPS procedure is relatively low, and some of them could recover through effective medical intervention. In our cohort, the overall incidence is about 3%, which causes 0.84% death. The most fatal complication is organ failure and hemobilia.

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Mechanical hemolysis after transjugular intrahepatic portosystemic shunt can occur with covered stent

Cited by 3 publications

References 6 publications

TIPS and splenorenal shunt for complications of portal hypertension in chronic hepatosplenic schistosomiasis–A case series and review of the literature

TIPS and splenorenal shunt for complications of portal hypertension in chronic hepatosplenic schistosomiasis–A case series and review of the literature

Transjugular intrahepatic portosystemic shunt-induced hemolysis in a non-cirrhotic patient: a case report

Covered TIPS Procedure-Related Major Complications: Incidence, Management and Outcome From a Single Center

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