CASE 480 Published on 02.04.2000

Percutaneous revision of acute TIPS thrombosis

Section

Interventional radiology

Case Type

Clinical Cases

Authors

D.Vorwerk

Patient

31 years, female

Clinical History
Acute thrombosis of TIPS tract and percutaneous management
Imaging Findings
Patient underwent TIPS placement one day earlier for subacute Budd-Chiari syndrome. Despite full anticoagulation, CCDS detected complete no flow within the TIPS tract the next morning and slective angiography was performed. It detected complete thrombosis of the TIPS tract (Fig. 1 a). After passage of a catheter into the portal vein through the thrombosis, portal vein was tested to be patent. Probable reason for thrombosis was an inadequate postion of the portal end of the stent against the portal wall.
Discussion
Firstly, balloon dilation of the TIPS tract was performed showing remaining thrombus within the shunt (Fig.2). In addition, a longer stent (Wallstent) of 14 mm dimater was placed within the distal portal vein and covering the whole TIPS tract immediately restoring flow into the shunt. Acceptable shunt function was indicated by nearly no filling of the intrahepatic portal branches (Fig. 2). Patient was long-term anticoagulated and was discharged 3 weeks later. As alternatives, thrombolysis or mechanical thrombectomy would have been options. Additional stenting was requested in order to improve the inflow into the TIPS tract. Portal stenting is problematic but no other option was given in order to avoid early recurrence of TIPS failure.
Differential Diagnosis List
Percuraneous management of acute TIPS thrombosis
Final Diagnosis
Percuraneous management of acute TIPS thrombosis
Case information
URL: https://eurorad.org/case/480
DOI: 10.1594/EURORAD/CASE.480
ISSN: 1563-4086