Flouroscopically–guided transhepatic puncture for difficult TIPS re-do procedures utilizing the En Snare retrieval device: A new approach to occluded TIPS in patients with recurrent ascites |
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| Authors: | Glenn W Stambo Matthew H Berlet |
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| Institution: | 1. Armstrong Institute for Patient Safety and Quality and Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD;2. Johns Hopkins Carey School of Business, Baltimore, MD;3. Armstrong Institute for Patient Safety and Quality, and Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD;4. Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD;1. Department of Surgery, Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL;2. Department of Interventional Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL;1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea;2. Department of Biostatistics, Yonsei University College of Medicine, Seoul, Republic of Korea;3. Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea;4. Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea;1. Department of Surgery, Seoul National University College of Medicine, Seoul, Korea;2. Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea;1. Department of Chemistry, Faculty of Science, Ubon Ratchathani University,Ubon Ratchathani 34190, Thailand;2. Research and Innovation in Science Education (RISE) Center, Faculty of Science, Ubon Ratchathani University, Ubon Ratchathani 34190, Thailand;3. Student, Master of Science in Science Education Program, Faculty of Science, Ubon Ratchathani University, Ubon Ratchathani 34190, Thailand |
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| Abstract: | Portal hypertension and variceal bleeding are complications due to cirrhosis. Transjugular Intraphepatic Portosystemic shunt (TIPS) procedure is a well-established treatment for recurrent ascites and variceal bleeding related to portal hypertension. After a TIPS has been placed, the potential of TIPS occlusion or stenosis is high. A TIPS re-do procedure has been used in treatment of progressive clinical symptoms. The standard approach is via the jugular route to recannulate the TIPS shunt. Rarely, it cannot be performed from the jugular approach. Therefore, a fluoroscopically -guided transhepatic approach has been devised for these difficult situations. This case describes the use of the transhepatic route through an indwelling Viatorr covered stent utilizing an En-Snare device to help complete the TIPS re-do procedure. With this newer approach to TIPS re-do procedures, endovascular specialists can achieve TIPS patency despite difficult venous anatomical challenges and the various types of available TIPS stents presently on the market. |
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