Failed TIPS procedure
Alcoholic cirrhosis with previous TIPS procedure. Now ascites with Hb of 7.6 due to haematemesis.
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Despite a TIPS stent passing from the right hepatic vein/IVC to the portal vein there are still features of portal hypertension, i.e. an enlarged, enhancing paraumbilical vein (arrow), esophageal varices (arrow) and ascites. The stent is patent but contains filling defect at the IVC end consistent with mural clot.
TIPS is a procedure to decompress the portal venous system into the systemic venous circulation. The stent used in the procedure can become narrowed or occluded leading to recurrence of portal hypertension.