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. 2024 Dec 23;7(1):91.
doi: 10.1186/s42155-024-00510-1.

"Bottoms-up" portal venous recanalization TIPS (PVR-TIPS) utilizing a re-entry catheter

Alexander Loizides  1 , Martin Freund  2 , Heinz Zoller  3 , Benedikt Schäfer  3
Affiliations

"Bottoms-up" portal venous recanalization TIPS (PVR-TIPS) utilizing a re-entry catheter

Alexander Loizides et al. CVIR Endovasc. .

Abstract

Background: Three patients with portal hypertension and gastrointestinal bleeding due to non-cirrhotic portal vein thrombosis were treated with portal venous recanalization transjugular intrahepatic portosystemic shunt (PVR-TIPS) via a trans-splenic access.

Main body: A "bottoms-up" retrograde puncture of the right hepatic vein was performed using a re-entry catheter to gain access to the right hepatic vein. In all patients a successful retrograde puncture of the right hepatic vein was achieved, thereby restoring the splenoportal tract.

Conclusion: Our cases present an alternative approach to treat chronic portal vein thrombosis expanding the possibilities of the PVR-TIPS procedure.

Keywords: PVR-TIPS; Portal vein thrombosis; Re-entry catheter; TIPS.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Consent for publication: Informed consent was obtained from all individual participants included in the study. Competing interests: The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Case 1-DSA via a transsplenic access depicting the subtotal thrombosed PV as well as large gastrooesophageal varices a. „Bottoms-up“ retrograde puncture of an inflated balloon in the RHV using a re-entry catheter system b. Snaring of a 0.018 inch guidewire in the right atrium c. Final DSA depicting a patent splenoportal tract d
Fig. 2
Fig. 2
Case 2-DSA via a transsplenic access depicting a cavernous transformation of the PV as well as gastrooesophageal varices a. After „Bottoms-up“ retrograde direct puncture of the RHV a 0.018 inch guidewire was advanced in the IVC b. Snaring of the guidewire in the right atrium c. Final DSA depicting a patent splenoportal tract d
Fig. 3
Fig. 3
Case 3 - DSA via a transsplenic access cavernous transformation of the PV a. „Bottoms-up“ retrograde direct puncture of the RHV using a re-entry catheter system b. Snaring of a 0.018 inch guidewire in the right atrium c. Final DSA depicting a patent splenoportal tract d
See this image and copyright information in PMC

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