Recanalization of occlusive transjugular intrahepatic portosystemic shunts inaccessible to the standard trans-venous approach

Abstract

The aim of this study was to evaluate the feasibility and safety of recanalization of occlusive transjugular intrahepatic portosystemic shunts (TIPS) that are inaccessible to the standard transvenous approach in patients with occlusive bare and covered stents. From July 1999 to July 2011, 430 consecutive TIPS were performed at a single institution in patients with chronic liver diseases and complications of portal hypertension. During the follow-up, a TIPS occlusion was detected in 20 cases that could not be crossed using a standard transvenous technique with a hydrophilic guidewire. Five cases had a bare stent, and 15 cases had a covered stent. In 19 cases (95%), the Colapinto needle technique was used. The Colapinto needle was advanced at the mouth of the occluded TIPS (n=2) or within the thrombus in the middle-distal shunt (n=16) to provide aid in advancing the hydrophilic guidewire into the portal vein. In one patient, after failure of the Colapinto technique, the combined transhepatic and transvenous approach was used. All of the procedures were successfully performed without complications. In patients with occlusive TIPS, stent recanalization is feasible and safe. The Colapinto needle technique should be used as the first approach, reserving the combined transhepatic and transvenous approach only for failure of this technique.