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Updated: Aug 31, 2026

Technique of Porcine Liver Procurement and Orthotopic Transplantation using an Active Porto-Caval Shunt
Published on: May 7, 2015
Direct intrahepatic portocaval shunt for refractory hepatic hydrothorax: a case report
Yo Kawahara1, Yoshihiro Tanaka1, Naoaki Isoi1
1Department of Traumatology and Critical Care Medicine National Defense Medical College Saitama Japan.
Case:
A 64-year-old man with complaints of dyspnea and orthopnea secondary to a hepatic hydrothorax refractory to diuretic medication underwent the transjugular intrahepatic portosystemic shunt (TIPS) procedure to decrease the portal vein pressure. The TIPS procedure failed due to severe liver stiffness. Direct intrahepatic portocaval shunt (DIPS), a modified TIPS procedure that directly inserts a stent from the inferior vena cava to the portal vein, was successfully carried out.
Outcome:
The DIPS procedure significantly decreased the patient's pleural effusion and respiratory symptoms.
Conclusion:
No other medical treatment is available to control refractory pleural effusion caused by portal hypertension; however, the TIPS (or DIPS) procedure can be successfully carried out in patients <60 years old with a Model of End-Stage Liver Disease score <15.
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