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CardioVascular and Interventional Radiology

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01-04-2011 | Technical Note

Pull-Through Technique for Recanalization of Occluded Portosystemic Shunts (TIPS): Technical Note and Review of the Literature

Authors: Toshihiro Tanaka, Rolf W. Günther, Peter Isfort, Kimihiko Kichikawa, Andreas H. Mahnken

Published in: CardioVascular and Interventional Radiology | Issue 2/2011

Abstract

Transjugular intrahepatic portosystemic shunt (TIPS) dysfunction is an important problem after creation of shunts. Most commonly, TIPS recanalization is performed via the jugular vein approach. Occasionally it is difficult to cross the occlusion. We describe a hybrid technique for TIPS revision via a direct transhepatic access combined with a transjugular approach. In two cases, bare metal stents or polytetrafluoroethylene (PTFE)-covered stent grafts had been placed in TIPS tract previously, and they were completely obstructed. The tracts were inaccessible via the jugular vein route alone. In each case, after fluoroscopy or computed tomography-guided transhepatic puncture of the stented segment of the TIPS, a wire was threaded through the shunt and snared into the right jugular vein. The TIPS was revised by balloon angioplasty and additional in-stent placement of PTFE-covered stent grafts. The patients were discharged without any complications. Doppler sonography 6 weeks after TIPS revision confirmed patency in the TIPS tract and the disappearance of ascites. We conclude that this technique is feasible and useful, even in patients with previous PTFE-covered stent graft placement.

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Title: Pull-Through Technique for Recanalization of Occluded Portosystemic Shunts (TIPS): Technical Note and Review of the Literature
Authors: Toshihiro Tanaka
Rolf W. Günther
Peter Isfort
Kimihiko Kichikawa
Andreas H. Mahnken
Publication date: 01-04-2011
Publisher: Springer-Verlag
Published in: CardioVascular and Interventional Radiology / Issue 2/2011
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-010-9874-2

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Springer Medicine

Pull-Through Technique for Recanalization of Occluded Portosystemic Shunts (TIPS): Technical Note and Review of the Literature

Abstract

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