Surgical salvage after failed transjugular intrahepatic portosystemic shunting

The creation of an intrahepatic portosystemic shunt using an expandable stent introduced by a transjugular route constitutes an alternative to surgical shunts for the management of portal hypertension. A 61-year-old woman with Child C cryptogenic cirrhosis and acute variceal bleeding presented a massive haemoperitoneum due to a tear at the portal vein confluence during a failed attempt at TIPS. Surgical salvage consisting in an end-to-side portocaval shunt was performed under adverse conditions because of massive haemorrhagic infiltration of the hepatic pedicle. The patient died shortly after surgery of irreversible shock. A 61-year-old male with Child C alcoholic liver disease underwent an urgent TIPS procedure for recurrent variceal bleeding. However, the stent was placed too distally, at the splenomesenteric junction, causing splenic and portal vein thrombosis. After surgical removal of the impacted stent and thrombectomy, an end-to-side portocaval shunt was performed. The patient died 1 month later of infected ascites. Although serious procedural complications are uncommon in expert hands, transjugular intrahepatic portosystemic shunting is an invasive technique that is associated with potentially fatal complications.