Redo surgery for portacaval shunt dysfunction after TIPS procedure

Zatevakhin I.I.

N.I. Pirogov Russian Research Medical University

Tsitsiashvili M.Sh.

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

Shipovskiĭ V.N.

Kafedra fakul'tetskoĭ khirurgii lechebnogo fakul'teta;
kafedra khirurgicheskikh bolezneĭ pediatricheskogo fakul'teta Rossiĭskogo gosudarstvennogo meditsinskogo universiteta, Moskva

Monakhov D.V.

Chair of Faculty-Based Surgery of pediatric faculty, Pirogov Russian National Research Medical University, Moscow, Russia;
Pletnev Municipal Clinical Hospital, Moscow, Russia

Chelyapin A.S.

Chair of Faculty-Based Surgery of pediatric faculty, Pirogov Russian National Research Medical University, Moscow, Russia;
Pletnev Municipal Clinical Hospital, Moscow, Russia

Redo surgery for portacaval shunt dysfunction after TIPS procedure

Authors:

Zatevakhin I.I., Tsitsiashvili M.Sh., Shipovskiĭ V.N., Monakhov D.V., Chelyapin A.S.

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Journal: Pirogov Russian Journal of Surgery. 2019;(6): 11‑19

DOI: 10.17116/hirurgia201906111

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To cite this article:

Zatevakhin II, Tsitsiashvili MSh, Shipovskiĭ VN, Monakhov DV, Chelyapin AS. Redo surgery for portacaval shunt dysfunction after TIPS procedure. Pirogov Russian Journal of Surgery. 2019;(6):11‑19. (In Russ.)
https://doi.org/10.17116/hirurgia201906111

Подписка 2025 (Pirogov Russian Journal of Surgery)

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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 2nd 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:

transjugular intrahepatic portosystemic shunt

dysfunction

redo suregry

portal hypertension

liver cirrhosis

Authors:

Zatevakhin I.I.

N.I. Pirogov Russian Research Medical University

Tsitsiashvili M.Sh.

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

Shipovskiĭ V.N.

Kafedra fakul'tetskoĭ khirurgii lechebnogo fakul'teta;
kafedra khirurgicheskikh bolezneĭ pediatricheskogo fakul'teta Rossiĭskogo gosudarstvennogo meditsinskogo universiteta, Moskva

Monakhov D.V.

Chair of Faculty-Based Surgery of pediatric faculty, Pirogov Russian National Research Medical University, Moscow, Russia;
Pletnev Municipal Clinical Hospital, Moscow, Russia

Chelyapin A.S.

Chair of Faculty-Based Surgery of pediatric faculty, Pirogov Russian National Research Medical University, Moscow, Russia;
Pletnev Municipal Clinical Hospital, Moscow, Russia

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