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Review
. 2024 Mar 14;41(1):92-96.
doi: 10.1055/s-0044-1779710. eCollection 2024 Feb.

A Simple "Involute" Technique for Successful Removal of a Caudally Migrated "Viatorr" Stent Graft

Vellia Zhou  1 , Mark Reddick  2 , Daniel Lamus  3 , Ronald S Arellano  4 , Sanjeeva P Kalva  4
Affiliations
Review

A Simple "Involute" Technique for Successful Removal of a Caudally Migrated "Viatorr" Stent Graft

Vellia Zhou et al. Semin Intervent Radiol. .
No abstract available

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Conflict of interest statement

Conflict of Interest None related to the manuscript.

Figures

Fig. 1
Fig. 1
Portal venography after accessing the left portal vein from the middle hepatic vein ( a ) shows a patent portal vein (open black arrow) and enlarged esophageal varices (closed black arrow). The additional sheath in the inferior vena cava/middle hepatic vein (white arrow) housed an intravascular ultrasound for guidance during the TIPS. Post-TIPS portal venography ( b and c ) shows a patent portal vein with accurately positioned TIPS (arrowhead) and persistent esophageal varices (closed black arrow).
Fig. 2
Fig. 2
Schematic demonstration of procedural steps. ( a ) The TIPS between the middle hepatic vein and left portal vein. ( b ) Caudal migration of Viatorr stent graft after a guide catheter (red) was advanced through the TIPS. ( c ) The 10-Fr sheath was exchanged for 16- and 10-Fr sheaths. An additional guide wire (buddy wire) (blue) was advanced by the side of the stent graft. ( d ) A Teflon-coated angled guide wire (purple) advanced from the lumen to the outside of the stent graft through the interstices of the bare portion of the stent graft. ( e ) A snare system (pink) was advanced through the 16-Fr sheath and snared by the Teflon-coated wire, forming a loop through a segment of the bare portion of the stent graft. ( f ) The looped wire was pulled out through the venous access sheath, “involuting” the stent graft in the process. ( g ) The involuted stent graft was removed via the venous access sheath. ( h ) Cross-sectional view of the “involute” technique where a loop is formed around a segment of the bare portion of the stent graft with the Teflon-coated guide wire (purple) and snare system (pink).
Fig. 3
Fig. 3
Portal venography ( a ) and fluoroscopic image ( b ) show caudal migration of the stent graft into the main portal vein.
Fig. 4
Fig. 4
Fluoroscopic image showing the deployment of the second sheath and buddy wire.
Fig. 5
Fig. 5
Fluoroscopic image showing Teflon-coated angled guide wire and snare system deployment ( 5a ) and then retraction of the stent graft into the sheath ( 5b ).
Fig. 6
Fig. 6
Image of retrieved stent graft.
Fig. 7
Fig. 7
Portal venography showing the final placement of TIPS stent graft.
See this image and copyright information in PMC

References

    1. Ferguson E, Cwikiel W. Percutaneous removal of two self-expanding stent grafts following failed deployment. Acta Radiol. 2006;47(07):667–671. - PubMed
    1. Ray M J, Savage C, Klintmalm G B, Rees C R. Endovascular caudal retraction of the cranial end of a misplaced Viatorr TIPS prior to liver transplantation. Proc Bayl Univ Med Cent. 2012;25(04):341–343. - PMC - PubMed
    1. Cwikiel W, Bergenfeldt M, Keussen I. Endovascular removal of the Viatorr stent-grafts. Report of two cases. Pol J Radiol. 2015;80:277–280. - PMC - PubMed
    1. Suhocki P V, Lungren M P, Kapoor B, Kim C Y. Transjugular intrahepatic portosystemic shunt complications: prevention and management. Semin Intervent Radiol. 2015;32(02):123–132. - PMC - PubMed
    1. Vu J, Kim S K. Percutaneous retrieval of a misplaced transjugular intrahepatic portosystemic shunt stent using the rigid endobronchial forceps. Int J Gastrointest Interv. 2016;5:156–158.