Transjugular intrahepatic portosystemic shunt (TIPS)
Patient admitted with fluid overload, ascites and pleural effusion. Past history of chronic liver disease due to hepatitis C.
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Procedure performed under general anaesthetic. A metallic marker (Tip of mandrel wire) was placed adjacent to a proximal branch of the right vein under ultrasound guidance. Following placement at the marker, a wedged right hepatic vein pressure was performed following a right-sided internal jugular puncture. The wedge pressure was 12 mmHg, the IVC was 1 mmHg. Following discussion with the referring team it was elected to proceed with the TIPS procedure.
Using the standard Cook TIPS set the superior branch of the right portal vein was punctured on the third attempt using a localisation marker and lateral screening and a glide wire and catheter advanced into the main portal vein. The pre stent deployment pressures measured were 20 mmHg in the main portal vein and 0 in the IVC. The tract was pre dilated with an 8 mm x 4 cm balloon and a Viator TIPS endoprosthesis stent (8cm covered, total length 10cm) was placed.. The stent was deployed under tension so as to have only the bare stent in the portal vein. The proximal end of the stent as deployed in a good position in the proximal IVC. Post deployment of the stent was inflated with a 10 mm x 4 cm balloon on three occasions and a TIPS venogram performed post this demonstrated a small filling defect consistent with a clot. This was aspirated successfully without consequence.
The pressures across the main portal vein through to the IVC were measured and post procedure they were 13 at the main portal vein, 7 in the distal stent, 7 in the mid stent, 6 in the proximal stent and 6 in the IVC.
Successful deployment of an 8 cm covered Viator TIPS stent between the right hepatic vein and proximal right portal vein with no complications and good functioning of the stent post procedure.
Transjugular intrahepatic portosystemic shunts (TIPS) are created in patients with intractable portal hypertension.