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Recanalization of Occluded TIPS Using a Transhepatic Percutaneous Technique 

Recanalization of Occluded TIPS Using a Transhepatic Percutaneous Technique
Chapter:
Recanalization of Occluded TIPS Using a Transhepatic Percutaneous Technique
Author(s):

Saher S. Sabri

DOI:
10.1093/med/9780199986071.003.0080
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date: 22 October 2020

Transjugular intrahepatic portosystemic shunt (TIPS) dysfunction rates have significantly decreased since the introduction of stent grafts. However, TIPS occlusion remains a recognized complication, especially when bare-metal stents are used or when the cephalad end of the stent does not extend into the inferior vena cava (IVC). Antegrade recanalization of the occluded TIPS can be routinely achieved using a coaxial or a triaxial sheath system, which provides sufficient stability and pushability to recanalize the TIPS. However, occasionally this cannot be achieved due to the difficult angulation between the IVC and the hepatic vein, poor placement of the initial TIPS short of the IVC, or long-standing occlusion of the TIPS. Retrograde recanalization of the TIPS by transhepatic percutaneous access of the TIPS using a 21 gauge needle can be performed in such situations.

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