Aortoatrial fistula complicating transjugular intrahepatic portosystemic shunt by protrusion of a stent into the right atrium: radiologic/pathologic correlation.

Numerous procedural complications of creation of a transjugular intrahepatic portosystemic shunt (TIPS) have been reported. In this article, a case of an aorto-right-atrial fistula after the revision of a TIPS is reported. The fistula developed from the free edge of a stent that protruded into the right atrium. The patient developed progressive right heart failure and eventually died of complications of right heart failure. Prevention of this potential complication with careful catheter manipulations under fluoroscopic observation around newly placed stents is recommended to prevent dislodgement of the stents. Careful deployment that avoids extension of the stent into the right atrium is essential to avoid the complication of cardiac perforation.