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. 2022 Apr 18;5(1):20.
doi: 10.1186/s42155-022-00297-z.

Refractory portal hypertension complications successfully managed by parallel transjugular intrahepatic portosystemic shunt (TIPS): a case report

Senali Weeratunga  1 , Mithun Nambiar  1   2 , Charles Handley  1   3 , Cosmin Florescu  1 , Stuart M Lyon  1 , Suong Le  3   4 , Diederick W De Boo  5
Affiliations

Refractory portal hypertension complications successfully managed by parallel transjugular intrahepatic portosystemic shunt (TIPS): a case report

Senali Weeratunga et al. CVIR Endovasc. .

Abstract

Background: Transjugular intrahepatic portosystemic shunt (TIPS) is an established intervention to treat complicated portal hypertension refractory to medical or endoscopic management. TIPS dysfunction results in the recurrence of portal hypertension symptoms. In cases of TIPS dysfunction or persistent portal hypertension despite a patent primary TIPS, the creation of parallel TIPS may be the only intervention to effectively reduce portal pressure. Since the introduction of dedicated TIPS stents (Viatorr®) the incidence of TIPS dysfunction has reduced profoundly. Nevertheless, the creation of a parallel TIPS can still be necessary in the current dedicated TIPS stent era.

Case presentation: We report one such patient who experienced ongoing portal hypertension induced upper gastro-intestinal haemorrhage despite multiple TIPS revisions and a patent primary TIPS.

Conclusion: Following creation of a parallel TIPS, the patient remains in clinical remission with no further bleeding.

Keywords: Interventional; Parallel shunt; Portal hypertension; TIPS.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Primary TIPS extending from right hepatic vein to left portal vein with Viatorr stent in situ (arrowheads). Venography confirms a widely patent shunt. Extravascular contrast is obscuring part of the stent at the portal entrance (arrow)
Fig. 2
Fig. 2
Venography of the first revision of the primary TIPS demonstrating (a) absence of flow through an occluded stent (arrows) due to thrombosis; (b) angioplasty with a fully inflated balloon; (c) successful recanalization of the TIPS with restored flow post angioplasty and further stent insertion
Fig. 3
Fig. 3
Venogram during the parallel TIPS procedure demonstrating (a) a patent primary shunt; (b) the newly created parallel TIPS (arrowheads) extending from the right hepatic vein to the right portal vein alongside the primary TIPS
See this image and copyright information in PMC

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