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CardioVascular and Interventional Radiology

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01-09-2017 | Case Report

Laser Recanalization of a Chronically Occluded Transjugular Intrahepatic Portosystemic Shunt (TIPS)

Authors: Alaa Mahmoud, David M. Tabriz, Beau B. Toskich

Published in: CardioVascular and Interventional Radiology | Issue 9/2017

Abstract

Transjugular intrahepatic portosystemic shunt (TIPS) dysfunction is conventionally managed with balloon angioplasty, stent extension, and sharp recanalization when necessary. We describe percutaneous transjugular recanalization and neointimal excision of a chronically occluded 17-year-old TIPS using excimer laser after conventional techniques were unsuccessful. Patient clinical improvement and shunt patency were documented three weeks post-intervention.

Tanaka T, Günther RW, Isfort P, Kichikawa K, Mahnken AH. Pull-through technique for recanalization of occluded portosystemic shunts (TIPS): technical note and review of the literature. Cardiovasc Intervent Radiol. 2011;34(2):406–12.CrossRefPubMed

Fidelman N, Kwan SW, LaBerge JM, Gordon RL, Ring EJ, Kerlan RK. The transjugular intrahepatic portosystemic shunt: an update. Am J Roentgenol. 2012;199(4):746–55.CrossRef

Larson M, Kirsch D, Kay D. Clinical images: parallel transjugular intrahepatic portosystemic shunt (TIPS) in the setting of TIPS occlusion. Ochsner J Summer. 2016;16(2):113–5.

Pereira K, Baker R, Salsamendi J, Doshi M, Kably I, Bhatia S. An approach to endovascular and percutaneous management of transjugular intrahepatic portosystemic shunt (TIPS) dysfunction: a pictorial essay and clinical practice algorithm. Cardiovasc Intervent Radiol. 2016;39(5):639–51.CrossRefPubMed

Miraglia R, Maruzzelli L, Luca A. Recanalization of occlusive transjugular intrahepatic portosystemic shunts inaccessible to the standard transvenous approach. Diagn Interv Radiol. 2013;19(1):61–5.PubMed

Habib A, Desai K, Hickey R, Thornburg B, Vouche M, Vogelzang RL, et al. Portal vein recanalization–transjugular intrahepatic portosystemic shunt using the transsplenic approach to achieve transplant candidacy in patients with chronic portal vein thrombosis. J Vasc Interv Radiol. 2015;26(4):499–506.CrossRefPubMed

Mehran R, Mintz GS, Satler LF, et al. Treatment of in-stent restenosis with excimer laser coronary angioplasty: mechanisms and results compared with PTCA alone. Circulation. 1997;96(7):2183–9. doi:10.1161/01.CIR.96.7.2183.CrossRefPubMed

Nishino M, Mori N, Takiuchi S, et al. Indications and outcomes of excimer laser coronary atherectomy: efficacy and safety for thrombotic lesions—the ULTRAMAN registry. J Cardiol. 2016;69:314–9.CrossRefPubMed

Dippel EJ, Makam P, Kovach R, et al. Randomized controlled study of excimer laser atherectomy for treatment of femoropopliteal in-stent restenosis: initial results from the EXCITE ISR Trial (EXCImer laser randomized controlled study for treatment of FemoropopliTEal in-stent restenosis). JACC Cardiovasc Interv. 2015;8(1):95–101.CrossRef

10.

Waheed A, Rajachandran M, Altin R, Klym K. An unusual case of renal artery stent restenosis: a case report. Angiology. 2007;58(2):249–54.CrossRefPubMed

11.

Yaqub Y, Suarez J, Jenkins LA. LASER endovascular atherectomy with secondary stenting of technically challenging calcified celiac trunk stenosis. Catheter Cardiovasc Interv. 2011;78(2):301–3.CrossRefPubMed

12.

Aye T, Phan TT, Muir DF, Linker NJ, Hartley R, Turley AJ. Novel experience of laser-assisted “inside-out” central venous access in a patient with bilateral subclavian vein occlusion requiring pacemaker implantation. Europace. 2016;1990:10–3.

13.

Lesher AP, Kratz JM, Smith CD. Removal of embedded central venous catheters. J Pediatr Surg. 2008;43(6):1030–4.CrossRefPubMed

14.

Worley SJ, Gohn DC, Pulliam RW. Excimer laser to open refractory subclavian occlusion in 12 consecutive patients. Heart Rhythm. 2010;7(5):634–8.CrossRefPubMed

15.

Kuo WT, Odegaard JI, Rosenberg JK, Hofmann LV. Excimer laser-assisted removal of embedded inferior vena cava filters a single-center prospective study. Circ Cardiovasc Interv. 2013;6(5):560–6.CrossRefPubMed

16.

Kuo WT, Odegaard JI, Rosenberg JK, Hofmann LV. Laser-assisted removal of embedded vena cava filters: a 5-year first-in-human study. Chest. 2017;151(2):417–24.CrossRefPubMed

17.

Kuo WT, Odegaard JI, Louie JD, et al. Photothermal ablation with the excimer laser sheath technique for embedded inferior vena cava filter removal: initial results from a prospective study. J Vasc Interv Radiol. 2011;22(6):813–23.CrossRefPubMed

Title: Laser Recanalization of a Chronically Occluded Transjugular Intrahepatic Portosystemic Shunt (TIPS)
Authors: Alaa Mahmoud
David M. Tabriz
Beau B. Toskich
Publication date: 01-09-2017
Publisher: Springer US
Published in: CardioVascular and Interventional Radiology / Issue 9/2017
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-017-1646-9

At a glance: The STEP trials

Springer Medicine

Laser Recanalization of a Chronically Occluded Transjugular Intrahepatic Portosystemic Shunt (TIPS)

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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