Transjugular Intrahepatic Portosystemic Shunt After Previous Recanalization of a Chronically Thrombosed Portal Vein via a Transmesenteric Approach

Abstract

We report a cirrhotic patient with complete occlusion of the portal vein with marked cavernous transformation due to chronic thrombosis in whom a transjugular intrahepatic portosystemic shunt (TIPS) was successfully created after direct minilaparotomy mesenteric vein catheterization, lysis and aspiration of the thrombus, and stenting in the portal vein. The methods used, we believe, provide a new technique for performing TIPS in chronically thrombosed portal veins in which previously no effective surgical therapeutic options were available.

Insulin independence achieved using the transmesenteric approach to the portal vein for islet transplantation

“…The frequency of other neoplasias is substantially lower, and the possible pathogenic pathways involved in their development are unknown. AML after liver transplantation (LT) is rare, with only six cases having been reported (2)(3)(4)(5)(6). Most AML cases are observed after renal transplantation (2), with some cases presenting after heart and lung transplantation (2,3).…”

“…Subsequently, several modifications to the original technique were introduced to overcome these problems, including reduction of the amount of heparin administered at the time of the transhepatic puncture and embolization of the needle tract after completion of the percutaneous procedure (1)(2)(3). We have used this approach to treat both cirrhotic and noncirrhotic patients with complete or near-complete occlusion of the portal vein (5)(6)(7). We have used this approach to treat both cirrhotic and noncirrhotic patients with complete or near-complete occlusion of the portal vein (5)(6)(7).…”

“…The transmesenteric approach to the portal vein has been described previously (5)(6)(7). The advantages of this approach in islet transplantation are the relative safety of the procedure and the ability to position the catheter centrally in the portal vein, ensuring equal distribution into the liver.…”

Non‐cavernomatous superior mesenteric thrombosis successfully recanalized with interventional radiological procedures carried out with a combination transmesenteric and transjugular approaches

“…Stent implantation in the TIPS tract at the time of interventional radiological procedures as treatment for portal venous thrombosis may be carried out for two important reasons. One is to obtain good outflow when sufficient outflow cannot be maintained by the intrahepatic portal vein alone even after relief of obstruction 2–4 . Stein and Link suggested that in using the intrahepatic portal vein as the outflow after reconstruction of portal venous blood flow with relief of obstruction, the following two conditions should be satisfied: (i) absence of hepatic cirrhosis; and (ii) patent intrahepatic portal branches of sufficient size 2 .…”

“…Although the placement of a transjugular intrahepatic portosystemic venous shunt (TIPS) has been widely accepted as an effective treatment for chronic gastrointestinal varices caused by portal hypertension, obstruction of the portal venous system has been considered an indication in relatively few cases or institutions 1 . However, the number of studies of TIPS for portal hypertension even with portal venous thrombosis, although few, has been increasing 1–7 …”