Transjugular intrahepatic portosystemic stent-shunt (TIPSS) insertion as a prelude to orthotopic liver transplantation in patients with severe portal hypertension

Tg, John; Jalan, Rajiv; Stanley, Adrian J.; Dn, Redhead; Sanfey, H; Hayes, PC; Oj, Garden

doi:10.1097/00042737-199612000-00002

Cited by 19 publications

(11 citation statements)

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“…At the present time, only TIPS can be considered as a reasonable alternative to PVS, and has already been proposed as a bridge to LT (25)(26)(27)(28). For the indication of refractory ascites, complete response after TIPS insertion can be estimated at 45% (95% CI: 39-50%) at 6 months (29).…”

Section: Discussionmentioning

confidence: 99%

Peritoneovenous Shunt as a Bridge to Liver Transplantation

Dumortier

Pianta

Derf

et al. 2005

American Journal of Transplantation

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Section: Discussionmentioning

confidence: 99%

Peritoneovenous Shunt as a Bridge to Liver Transplantation

Dumortier

Pianta

Derf

et al. 2005

American Journal of Transplantation

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“…3 However, in those cases in which the TIPS stent is either malpositioned or migrates into the vena cava, right atrium, or superior mesenteric vein, the complexity of transplantation is increased. 5,6 If the stent cannot be removed then, if it is available, healthy vein can be used for an interposition graft to the superior mesenteric vein.…”

Section: Discussionmentioning

confidence: 99%

“…1 Although most series have reported that TIPSs are a safe bridge to transplantation in selected patients, [2][3][4] there have been recent warnings to transplant surgeons regarding the specific complications of stent migration and malposition. 5,6 A TIPS may necessitate modification of the surgical procedure, but this is generally a surmountable problem.…”

mentioning

confidence: 99%

Liver transplantation complicated by embedded transjugular intrahepatic portosystemic shunt: A new method for portal anastomosis?a surgical salvage procedure

et al. 2000

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A transjugular intrahepatic portosystemic shunt (TIPS) is an increasingly used method of treating variceal bleeding from portal hypertension. Many patients are subsequently listed for transplantation, which may be complicated by malposition of the inferior end of the TIPS stent. This report details such a case and offers a surgical technique to salvage this situation. Copyright 2000 by the American Association for the Study of Liver DiseasesA transjugular intrahepatic portosystemic shunt (TIPS) is an effective treatment for variceal bleeding from portal hypertension. 1 Although most series have reported that TIPSs are a safe bridge to transplantation in selected patients, 2-4 there have been recent warnings to transplant surgeons regarding the specific complications of stent migration and malposition. 5,6 A TIPS may necessitate modification of the surgical procedure, but this is generally a surmountable problem. 7 We report a case of a malpositioned, impacted TIPS extending in the caudal direction that rendered a patient unsuitable for transplantation except by direct anastomosis onto the TIPS-portal vein complex. Case ReportA 43-year-old woman with hepatitis C and alcoholic cirrhosis underwent TIPS placement after 3 variceal bleeds, reducing her portal pressure from 34 to 30 mm Hg. She self-referred 7 months later, after having been lost to follow-up, with recurrent bleeding, lethargy, and worsening ascites, at which time a TIPSogram showed an occluded stent with an associated proximal thrombus that proved resistant to balloon dilatation. A second stent was introduced by the same approach through the initial TIPS and extended inferiorly down the portal vein in an attempt to displace the thrombus. This was successful, with a reduction in portal pressure from 28 to 17 mm Hg, but it was noted that the inferior end of the stent was lying at the portal vein origin. She was then listed for transplantation. A computed tomographic scan of her abdomen confirmed the second TIPS lying at the junction of her splenic and superior mesenteric veins, and angiography suggested extension of the TIPS into the superior mesenteric vein (Fig. 1). Her TIPS was dilated electively 6 months later, with portal pressure reduced from 28 to 21 mm Hg. She was admitted for transplantation, having had her original TIPS in situ for 16 months.At surgery, the initial TIPS stent was seen protruding through the portal vein wall, with the lower stent palpable throughout the length of the portal vein. The lower stent continued to be palpable through the base of the transverse mesocolon into the superior mesenteric vein in the infracolic compartment. The stent was associated with intense thickening of surrounding tissues.The patient was placed on venovenous bypass for the period of caval clamping. Once the recipient portal vein had been opened through the TIPS, it was found that removal of the stent was impossible because of embedding. However, no bare metal was exposed in the lumen, which had reendothelialized over the mesh metal. An anastomosis was ...

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“…TIPS does not facilitate or hinder liver transplantation, measured in terms of surgical time, blood-product requirements, graft survival, overall survival, and liver and renal function. 3 However, in those cases in which the TIPS stent is either malpositioned or migrates into the vena cava, right atrium, or superior mesenteric vein, the complexity of transplantation is increased. 5,6 If the stent cannot be removed then, if it is available, healthy vein can be used for an interposition graft to the superior mesenteric vein.…”

Section: Discussionmentioning

confidence: 99%

“…A transjugular intrahepatic portosystemic shunt (TIPS) is an effective treatment for variceal bleeding from portal hypertension. 1 Although most series have reported that TIPSs are a safe bridge to transplantation in selected patients, [2][3][4] there have been recent warnings to transplant surgeons regarding the specific complications of stent migration and malposition. 5,6 A TIPS may necessitate modification of the surgical procedure, but this is generally a surmountable problem.…”

mentioning

confidence: 99%