The Pull-Through Technique for Recanalization of Transjugular Intrahepatic Portosystemic Shunt Dysfunction.

Si-Liang Chen,Cheng-Jiang Xiao,Shuai Wang,Jian-Bo Zhao,Si-Yi Jin

doi:10.1155/2020/9150173

Abstract

Purpose To evaluate the technical efficacy and safety of the pull-through technique in recanalization of transjugular intrahepatic portosystemic shunt (TIPS) when standard transjugular approach is inaccessible. Materials and Methods A retrospective review of patients underwent TIPS revision via the pull-through technique was performed. Transhepatic directly punctured stent was conducted if the portal vein could not be accessed via standard transjugular approach. Technical success was defined by recanalization of shunt. Clinical success was defined as bleeding interruption and ascites regression without pharmacological support. All patients were followed up by clinical evaluation and Doppler ultrasound. Results Between January 2010 and December 2016, a total of 63 patients underwent TIPS revision, and 14 of them could not be accessed via standard transjugular approaches owing to stenosis or occlusion of the hepatic vein. The pull-through technique was successful in 13 patients, and one patient underwent parallel TIPS. No procedure-related complication was observed. One patient died of liver failure one week after the procedure. During the follow-up, three patients developed hepatic encephalopathy, and one patient developed TIPS dysfunction again and experienced variceal bleeding. The primary patency rate after TIPS revision was 92% (11/12) at 12 months. Conclusion The pull-through technique was effective and safe for recanalization of TIPS inaccessible via standard transjugular approach.

Highlights

Transjugular intrahepatic portosystemic shunt (TIPS) has been increasingly used for the treatment of portal hypertension-related complications, especially variceal bleeding and refractory ascites
We analyzed 14 (10 male and 4 female; mean age, 54:0 ± 12:9 years; age range, 26-71 years) of these 63 patients who underwent TIPS revision by pull-through approach because the portal vein could not be accessed via standard transjugular approaches (Table 1)
The transhepatically placed guide wire could not get through the occlusion at the distal tip

Summary

Introduction

Transjugular intrahepatic portosystemic shunt (TIPS) has been increasingly used for the treatment of portal hypertension-related complications, especially variceal bleeding and refractory ascites. The 1-year primary patency rate is usually less than 50% when bare stents are used [1]. With the use of expanded polytetrafluoroethylene(ePTFE-) covered stents, the long-term patency rate has significantly increased [2]. Shunt dysfunction still remains the main limitation. Standard transjugular approach is an important TIPS revision treatment for shunt dysfunction. Sometimes it is difficult to get through the stenosis or occlusion via standard transjugular approach. Haskal and Cope firstly reported the method that combined transhepatic and transvenous approach to treat for TIPS dysfunction [3]. Clinical experience regarding this technique is limited owing to only few relevant case reports [4,5,6]. The purpose of this study was to determine the efficacy and safety of the transhepatic guide wire pull-through technique in TIPS recanalization

Objectives

Methods

Results