Transjugular intrahepatic portosystemic shunt (TIPS) complications: what diagnostic radiologists should know

A Comprehensive Review of Transjugular Intrahepatic Portosystemic Shunt–Related Complications

“…Intraparenchymal bleeding can occur with formation of hematomas that can lead to biliary or portal compression; hematomas rarely become infected and require drainage. 13 Subcapsular hematomas can also occur after the wedge venography or the needle punctures ( Fig. 4 ).…”

“…15 Arterioportal fistulas could worsen the preexisting portal hypertension. 13 Embolization of the hepatic artery can be performed if the lesion is in a small peripheral branch or if significant bleeding occurred ( Fig. 6 ).…”

“…Accidental punctures of the bile ducts and gallbladder can occur in up to 5% of patients and usually will not require further interventions. 13 15 Punctures of the central hepatic ducts near the hilum are not too uncommon during TIPS as they are located next to the PV branches ( Fig. 11 ).…”

“…Rarely, significant bleeding inside the gallbladder could result in acute cholecystitis if the cystic duct gets occluded, and also bile leakage can occur if the wall of the gallbladder is damaged. 13 Puncture of the right kidney can occur in less than 1.5% and may lead to pericapsular hematomas or hematuria that is usually self-limited. Puncture of the bowel may increase the risk of infection.…”

“…Stent migration is more frequent with covered than with bare metal stents. 13 Proximal stent migration can occur more frequently than distal stent migration into the PV. Stent migration into the heart may rarely occur during stent revisions when overlapping stents are placed near the IVC.…”