Inadvertent arteriovenous stenting during transjugular intrahepatic portosystemic shunt procedure and the importance of hepatic artery perfusion

Penetrating the hepatic artery during transjugular intrahepatic portosystemic shunt (TIPS) is a relatively frequent but almost always benign complication. We report a patient in whom the right hepatic artery, originating from the superior mesenteric artery, was inadvertently catheterized and stented. The arteriovenous fistula was treated with a detachable balloon positioned within the hepatic artery. A second TIPS was attempted and successfully created during the same session. The patient died of cardiac failure, attributed to rapid resolution of massive ascites after TIPS with circulatory overload. At autopsy, the liver distal to the arterial occlusion balloon was infarcted, illustrating the importance of hepatic artery perfusion in liver cirrhosis.