OBJECTIVE: The purpose of this study was to determine the incidence and complications related to transjugular intrahepatic portosystemic shunt (TIPS) stents found in the portal vein at the time of an orthotopic liver transplantation. BACKGROUND: Transjugular intrahepatic portosystemic shunts are frequently used in patients with end-stage liver disease as a bridge to liver transplantation. The incidence of finding the metal stent outside of the liver parenchyma at the time of transplantation is reported as high as 30%. Most cases that have been detailed involve stents misplaced in the vena cava with various outcomes. Almost no data are available regarding stents misplaced into the portal vein. METHODS AND RESULTS: We report our experience with four patients with whom a TIPS stent was found misplaced in the portal vein at the time of liver transplantation, including one patient with a stent extending into the superior mesenteric vein. This patient required extensive venous reconstruction using a retropancreatic "pant" donor-iliac vein graft. The three other patients were transplanted without the need for extensive venous reconstruction. There was no significant difference in operative times for this group of patients, but there was a significant increase in the requirement for blood transfusion. In a follow-up period ranging from 6 months to 2 years, all patients remained alive and had normal portal venous flow and functioning allografts. Most misplaced stents were placed in patients with small cirrhotic livers and by radiologists with minimal experience with the procedure. CONCLUSIONS: Misplaced TIPS in the portal vein before liver transplantation is a more frequent complication than previously reported; however, it does not represent major technical difficulty if a clamp can be placed proximally on the portal vein. In the case of a stent extending below the spleno-mesenteric confluence, interposition grafts such as a donor-iliac vein graft are necessary for venous reconstruction. The experience of the radiologist is critical to prevent this complication.
OBJECTIVE: The purpose of this study was to determine the incidence and complications related to transjugular intrahepatic portosystemic shunt (TIPS) stents found in the portal vein at the time of an orthotopic liver transplantation. BACKGROUND: Transjugular intrahepatic portosystemic shunts are frequently used in patients with end-stage liver disease as a bridge to liver transplantation. The incidence of finding the metal stent outside of the liver parenchyma at the time of transplantation is reported as high as 30%. Most cases that have been detailed involve stents misplaced in the vena cava with various outcomes. Almost no data are available regarding stents misplaced into the portal vein. METHODS AND RESULTS: We report our experience with four patients with whom a TIPS stent was found misplaced in the portal vein at the time of liver transplantation, including one patient with a stent extending into the superior mesenteric vein. This patient required extensive venous reconstruction using a retropancreatic "pant" donor-iliac vein graft. The three other patients were transplanted without the need for extensive venous reconstruction. There was no significant difference in operative times for this group of patients, but there was a significant increase in the requirement for blood transfusion. In a follow-up period ranging from 6 months to 2 years, all patients remained alive and had normal portal venous flow and functioning allografts. Most misplaced stents were placed in patients with small cirrhotic livers and by radiologists with minimal experience with the procedure. CONCLUSIONS: Misplaced TIPS in the portal vein before liver transplantation is a more frequent complication than previously reported; however, it does not represent major technical difficulty if a clamp can be placed proximally on the portal vein. In the case of a stent extending below the spleno-mesenteric confluence, interposition grafts such as a donor-iliac vein graft are necessary for venous reconstruction. The experience of the radiologist is critical to prevent this complication.
Authors: G Moulin; P André; C Chagnaud; P Castellani; P Champsaur; J M Bartoli Journal: Cardiovasc Intervent Radiol Date: 1995 Sep-Oct Impact factor: 2.740
Authors: B Suc; J P Vinel; H Rousseau; P Maquin; F Holmière; G Fourtanier; L Rostaing; B Coustet; J P Pascal; F Joffre Journal: Transplant Proc Date: 1995-04 Impact factor: 1.066
Authors: J M LaBerge; E J Ring; R L Gordon; J R Lake; M M Doherty; K A Somberg; J P Roberts; N L Ascher Journal: Radiology Date: 1993-05 Impact factor: 11.105
Authors: E S Woodle; M Darcy; H M White; G A Perdrizet; T M Vesely; D Picus; M Hicks; S K So; M D Jendrisak; C S McCullough Journal: Surgery Date: 1993-03 Impact factor: 3.982
Authors: M Millis; D Imagawa; K Olthoff; P Martin; A Gomes; A Shaked; H Yersiz; K Drazan; O Jurim; L Goldstein Journal: Transplant Proc Date: 1995-02 Impact factor: 1.066
Authors: M W Wilson; R L Gordon; J M LaBerge; R K Kerlan; P M Radosevich; J P Roberts; E J Ring Journal: J Vasc Interv Radiol Date: 1995 Sep-Oct Impact factor: 3.464
Authors: M Rössle; K Haag; A Ochs; M Sellinger; G Nöldge; J M Perarnau; E Berger; U Blum; A Gabelmann; K Hauenstein Journal: N Engl J Med Date: 1994-01-20 Impact factor: 91.245
Authors: A C Stieber; G Zetti; S Todo; A G Tzakis; J J Fung; I Marino; A Casavilla; R R Selby; T E Starzl Journal: Ann Surg Date: 1991-03 Impact factor: 12.969
Authors: Damian J Harding; M Thamara P R Perera; Frederick Chen; Simon Olliff; Dhiraj Tripathi Journal: World J Gastroenterol Date: 2015-06-14 Impact factor: 5.742