Failed TIPS procedure

Case contributed by Chris O'Donnell

Presentation

Alcoholic cirrhosis with previous TIPS procedure. Now ascites with Hb of 7.6 due to hematemesis.

Patient Data

Age: 60 years
Gender: Male
ct

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.

Case Discussion

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. 

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