E-ISSN: 1305-3612
Recanalization of occlusive transjugular intrahepatic portosystemic shunts inaccessible to the standard transvenous approach
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Interventional Radiology - Technical Note
VOLUME: 19 ISSUE: 1
P: 61-65
January 2013

Recanalization of occlusive transjugular intrahepatic portosystemic shunts inaccessible to the standard transvenous approach

Diagn Interv Radiol 2013;19(1):61-65
DOI: 10.4261/1305-3825.DIR.5541-12.1
Roberto Miraglia, 1
Luigi Maruzzelli, 1
Angelo Luca 2
1. Department of Diagnostic and Interventional Radiology, Mediterranean Institute for Transplantation and Advanced Specialized Therapies, Palermo, Italy
2. Department of Radiology, Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
No information available.
No information available
Received Date: 11.01.2012
Accepted Date: 07.05.2012
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ABSTRACT

PURPOSE

The aim of this study was to evaluate the feasibility and safety of recanalization of occlusive transjugular intrahepatic portosystemic shunts (TIPS) that are inaccessible to the standard transvenous approach in patients with occlusive bare and covered stents.

MATERIALS AND METHODS

From July 1999 to July 2011, 430 consecutive TIPS were performed at a single institution in patients with chronic liver diseases and complications of portal hypertension. During the follow-up, a TIPS occlusion was detected in 20 cases that could not be crossed using a standard transvenous technique with a hydrophilic guidewire.

RESULTS

Five cases had a bare stent, and 15 cases had a covered stent. In 19 cases (95%), the Colapinto needle technique was used. The Colapinto needle was advanced at the mouth of the occluded TIPS (n=2) or within the thrombus in the middle-distal shunt (n=16) to provide aid in advancing the hydrophilic guidewire into the portal vein. In one patient, after failure of the Colapinto technique, the combined transhepatic and transvenous approach was used. All of the procedures were successfully performed without complications.

CONCLUSION

In patients with occlusive TIPS, stent recanalization is feasible and safe. The Colapinto needle technique should be used as the first approach, reserving the combined transhepatic and transvenous approach only for failure of this technique.