Acute liver failure after a late TIPSS revision

Area of Science:

• Hepatology
• Interventional Radiology
• Transplantation Surgery

Background:

• Transjugular intrahepatic portosystemic stent shunt (TIPSS) is a procedure used to manage complications of portal hypertension.
• Liver cirrhosis, particularly post-alcoholic, is a common indication for TIPSS, often as a bridge to transplantation.
• Late complications of TIPSS, such as occlusion, can significantly impact patient outcomes.

Observation:

• A rare case of late TIPSS occlusion was observed 2 years after the initial procedure.
• The occlusion was attributed to progressive stent protrusion into the periportal liver parenchyma.
• This protrusion was linked to delayed liver shrinkage following the initial TIPSS placement.

Findings:

• The patient underwent a TIPSS procedure as a bridge to liver transplantation due to post-alcoholic liver cirrhosis.
• A novel TIPSS recanalization and revision technique was successfully applied to address the stent protrusion and occlusion.
• Despite the revision, the patient developed acute liver failure immediately post-procedure.

Implications:

• This case highlights a rare but serious late complication of TIPSS related to liver volume changes.
• The described revision technique offers a potential solution for managing stent protrusion.
• The rapid progression to acute liver failure underscores the critical nature of TIPSS revision and the need for vigilant monitoring in patients with liver cirrhosis.