The Pull-Through Technique for Recanalization of Transjugular Intrahepatic Portosystemic Shunt Dysfunction

Si-Liang Chen; Cheng-Jiang Xiao; Shuai Wang; Si-Yi Jin; Jian-Bo Zhao

doi:10.1155/2020/9150173

The Pull-Through Technique for Recanalization of Transjugular Intrahepatic Portosystemic Shunt Dysfunction

Gastroenterol Res Pract. 2020 Apr 27:2020:9150173. doi: 10.1155/2020/9150173. eCollection 2020.

Authors

Si-Liang Chen¹, Cheng-Jiang Xiao¹, Shuai Wang², Si-Yi Jin³, Jian-Bo Zhao⁴

Affiliations

¹ Department of Interventional Radiology, Guangdong Second Provincial General Hospital, Guangzhou, 510317 Guangdong, China.
² Department of Intensive Care Unit, Guangzhou Hospital of Integrated Traditional and West Medicine, Guangzhou, 510800 Guangdong, China.
³ Internal Medicine Training Base, Guangdong Second Provincial General Hospital, Guangzhou, 510317 Guangdong, China.
⁴ Division of Vascular and Interventional Radiology, Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515 Guangdong, China.

Abstract

Purpose: To evaluate the technical efficacy and safety of the pull-through technique in recanalization of transjugular intrahepatic portosystemic shunt (TIPS) when standard transjugular approach is inaccessible.

Materials and methods: A retrospective review of patients underwent TIPS revision via the pull-through technique was performed. Transhepatic directly punctured stent was conducted if the portal vein could not be accessed via standard transjugular approach. Technical success was defined by recanalization of shunt. Clinical success was defined as bleeding interruption and ascites regression without pharmacological support. All patients were followed up by clinical evaluation and Doppler ultrasound.

Results: Between January 2010 and December 2016, a total of 63 patients underwent TIPS revision, and 14 of them could not be accessed via standard transjugular approaches owing to stenosis or occlusion of the hepatic vein. The pull-through technique was successful in 13 patients, and one patient underwent parallel TIPS. No procedure-related complication was observed. One patient died of liver failure one week after the procedure. During the follow-up, three patients developed hepatic encephalopathy, and one patient developed TIPS dysfunction again and experienced variceal bleeding. The primary patency rate after TIPS revision was 92% (11/12) at 12 months.

Conclusion: The pull-through technique was effective and safe for recanalization of TIPS inaccessible via standard transjugular approach.