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Case Reports
. 2017 Feb 20;12(2):327-330.
doi: 10.1016/j.radcr.2017.01.013. eCollection 2017 Jun.

TIPS performed in a patient with complete portal vein thrombosis

Ashwani Kumar Sharma  1 , David Charles Kaufman  2
Affiliations
Case Reports

TIPS performed in a patient with complete portal vein thrombosis

Ashwani Kumar Sharma et al. Radiol Case Rep. .

Abstract

Portal vein thrombosis is common in cirrhotic patients and results in increased morbidity and mortality. Transjugular intrahepatic portosystemic shunt (TIPS) creation is a well-established therapy for refractory variceal bleeding and refractory ascites in patients who do not tolerate repeated large volume paracentesis. Experience and technical improvements have led to improved TIPS outcomes that have encouraged an expanded application. Complete portal vein thrombosis has come a long way from being a contraindication to an indication for TIPS procedure. As experience and technology have evolved, the ultrasound guidance transvenous access of portal vein from the hepatic vein help in overall higher success rate of performing the TIPS procedure and reducing the procedure-related complications.

Keywords: Complete portal vein thrombosis; TIPS.

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Figures

Fig. 1
Fig. 1
(A) CO2 portovenogram through balloon catheter (horizontal arrow) in the right hepatic vein demonstrates nonvisualization of the portal vein and multiple collaterals in the region of portal vein (vertical arrows). (B) Doppler ultrasound of the liver demonstrates no flow in the portal vein with multiple collaterals around it suggesting cavernous transformation. (C) Demonstrates advancement of the Colapinto needle (horizontal arrow) under ultrasound guidance into the thrombosed right branch of portal vein (vertical arrow).
Fig. 2
Fig. 2
(A) Portovenogram through the flush catheter (horizontal arrows) demonstrates complete occlusion of the portal vein with prominent gastroesophageal varices (solid horizontal arrows) and inflated Minnesota tube (vertical arrows). (B) Fluoroscopic image demonstrates dilatation of the portal vein with 10 mm Conquest balloon (long horizontal arrow) placed through the Viatorr stent (short horizontal arrow). Embolized gastroesophageal varies (solid horizontal arrows) are noted along with inflated Minnesota tube (vertical arrows). (C) Portovenogram demonstrates establishment of flow through the portal vein into the TIPS shunt (horizontal arrows) with nonvisualization of the gastric and perisplenic collaterals. N-BCA glue is noted in the embolized gastroesophageal varices.
Fig. 3
Fig. 3
Portovenogram demonstrates patent TIPS shunt and the main portal vein with nonvisualization of the right and left portal vein branches.
See this image and copyright information in PMC

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