Transjugular Intrahepatic Portosystemic Shunt Using the Trans-splenic Approach and a Snare Technique

Abstract

Transjugular intrahepatic portosystemic shunt (TIPS) is an established procedure for the secondary prevention of variceal bleeding and management of refractory ascites. Portal vein thrombosis presents technical difficulty during TIPS due to nonvisualization of portal vein. In such patients, trans-splenic approach can be utilized to navigate thrombosed portal vein and use a snare as a fluoroscopic guidance for the intraparenchymal pass. We present the case of a 63-year old man who received the successful TIPS procedure via trans-splenic access without any complication.

Keywords

transjugular intrahepatic portosystemic shunt - trans-splenic approach - portal vein thrombosis

• References

• 1 Fidelman N, Kwan SW, LaBerge JM, Gordon RL, Ring EJ, Kerlan Jr RK. The transjugular intrahepatic portosystemic shunt: an update. AJR Am J Roentgenol 2012; 199 (04) 746-755
• 2 Zheng M, Chen Y, Bai J. , et al. Transjugular intrahepatic portosystemic shunt versus endoscopic therapy in the secondary prophylaxis of variceal rebleeding in cirrhotic patients: meta-analysis update. J Clin Gastroenterol 2008; 42 (05) 507-516
• 3 Narahara Y, Kanazawa H, Fukuda T. , et al. Transjugular intrahepatic portosystemic shunt versus paracentesis plus albumin in patients with refractory ascites who have good hepatic and renal function: a prospective randomized trial. J Gastroenterol 2011; 46 (01) 78-85
• 4 Chu HH, Kim HC, Jae HJ. , et al. Percutaneous transsplenic access to the portal vein for management of vascular complication in patients with chronic liver disease. Cardiovasc Intervent Radiol 2012; 35 (06) 1388-1395
• 5 Probst P, Rysavy JA, Amplatz K. Improved safety of splenoportography by plugging of the needle tract. AJR Am J Roentgenol 1978; 131 (03) 445-449
• 6 Zhu K, Meng X, Zhou B. , et al. Percutaneous transsplenic portal vein catheterization: technical procedures, safety, and clinical applications. J Vasc Interv Radiol 2013; 24 (04) 518-527
• 7 Thornburg B, Desai K, Hickey R. , et al. Portal vein recanalization and transjugular intrahepatic portosystemic shunt creation for chronic portal vein thrombosis: technical considerations. Tech Vasc Interv Radiol 2016; 19 (01) 52-60
• 8 Habib A, Desai K, Hickey R. , 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 (04) 499-506