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[Redo surgery for portacaval shunt dysfunction after TIPS procedure]

I I Zatevakhin¹, M Sh Tsitsiashvili¹, V N Shipovskiy¹

¹Chair of Faculty-Based Surgery of pediatric faculty, Pirogov Russian National Research Medical University, Moscow, Russia.

|July 19, 2019

Abstract

Aim:

To analyze various methods for treatment of TIPS dysfunction.

Material And Methods:

There were 45 patients (29 men, 16 women, aged 52.2±2.03 years) with TIPS dysfunction. Dysfunction of bare-metal stent was noted in 29 cases, stent-graft - in 16 cases. TIPS thrombosis occurred in 24 patients, hyperplasia of hepatic vein intima - in 7, pseudointimal hyperplasia of the shunt - in 7, liver tissue prolapse - in 5, migration of stent - in 2 patients. Redo surgery included rheolytic thrombectomy, balloon angioplasty, stent-in-stent technique, u-shaped and parallel stenting.

Results:

Patients were hospitalized in 3, 6 and 12 months after surgery for evaluation of the results of redo interventions. Balloon angioplasty and rheolytic thrombectomy (5 patients) were followed by TIPS dysfunction after 1 week in 2 patients, after 12 months - in 2. Normal function of stent over 1 year was noted in 1 patient. Isolated balloon angioplasty (n=23) was followed by TIPS dysfunction within 1 week in 13 patients, within 3 months in 3 patients, up to 6 months in 1 patient, within 6-12 months in 1 patient. Normal function of TIPS over 1 year was observed in 4 patients. Stent-in-stent stenting (n=18) was followed by early thrombosis in 5 patients, normal function of TIPS up to 3 months was noted in 3 patients, within 3-6 months - in 2 patients, up to 1 year - in 1 patient. Normal function of TIPS over 1 year was observed in 7 patients. TIPS thrombosis occurred in 1 patient on the 2^nd day after U-shaped stenting. Normal function of TIPS over 1 year was observed in another patient after the same procedure. Early TIPS dysfunction occurred in 2 patients after parallel stenting, dysfunction within 3 months was revealed in 2 patients. Normal function of TIPS over 1 year was observed in 2 patients.

Conclusion:

Rheolytic thrombectomy combined with balloon angioplasty is preferred for early TIPS dysfunction. Parallel stenting is advisable in long-term period. The use of stent grafts as a shunt can reduce the incidence of TIPS dysfunction.

Keywords:

dysfunction liver cirrhosis portal hypertension redo suregry transjugular intrahepatic portosystemic shunt

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