REGULAR CONTENT
Final ID
654
Type
Educational Exhibit-Poster Only
Authors
H Charles1, S Wu2
Institutions
1South Florida Vascular Associates, Coconut Creek, FL, 2University of Pennsylvania, Philadelphia, PA
Purpose
To describe the left-to-left transjugular intrahepatic portosystemic shunt (TIPS) procedure and to evaluate its clinical and technical indications, efficacy, and safety. Left-to-left TIPS is defined as left or middle hepatic vein (HV) access to the left main or branch portal vein (PV)
Materials & Methods
From September 2010 through December 2015, a total of 23 left-to-left TIPS procedures were performed. Clinical indications were as follows: refractory ascites (n = 10); refractory ascites + hydrothorax (n = 1); refractory ascites + progressive PV thrombosis (n = 2); progressive PV thrombosis (n = 5); variceal bleeding (n = 8); recurrent variceal bleeding + failed right TIPS (n = 1); occlusion of right TIPS (n = 1). Pre-TIPS liver CT or MRI and TIPS creation procedure angiograms were retrospectively reviewed.
Results
Twenty-two of 23 (96%) left-to-left TIPS creations were technically successful. One left-to-left access was successful but an exaggerated tortuous wire course could not be reduced; a right-to-right access was secured, allowing for successful TIPS creation. Technical considerations for the left-to-left TIPS approach were: small right PV, larger left PV (n = 7); diseased right HV (n = 2); no right PV (n = 2); extra-hepatic right PV (n = 1); right TIPS thrombosis and need for new, parallel TIPS creation (n = 1); no dominant or early arborizing main right PV (n = 4); right liver hepatocellular carcinoma (HCC) (n = 2); right liver HCC + right PV thrombosis (n = 1); cavernous right PV (n = 1); hepatofugal portal venous flow (n = 1); non-specific (n = 1).
Conclusions
Left or middle hepatic to left portal vein TIPS creation is technically feasible. This approach to transhepatic portal decompression is indicated in the appropriate clinical and technical settings
Final ID
654
Type
Educational Exhibit-Poster Only
Authors
H Charles1, S Wu2
Institutions
1South Florida Vascular Associates, Coconut Creek, FL, 2University of Pennsylvania, Philadelphia, PA
Purpose
To describe the left-to-left transjugular intrahepatic portosystemic shunt (TIPS) procedure and to evaluate its clinical and technical indications, efficacy, and safety. Left-to-left TIPS is defined as left or middle hepatic vein (HV) access to the left main or branch portal vein (PV)
Materials & Methods
From September 2010 through December 2015, a total of 23 left-to-left TIPS procedures were performed. Clinical indications were as follows: refractory ascites (n = 10); refractory ascites + hydrothorax (n = 1); refractory ascites + progressive PV thrombosis (n = 2); progressive PV thrombosis (n = 5); variceal bleeding (n = 8); recurrent variceal bleeding + failed right TIPS (n = 1); occlusion of right TIPS (n = 1). Pre-TIPS liver CT or MRI and TIPS creation procedure angiograms were retrospectively reviewed.
Results
Twenty-two of 23 (96%) left-to-left TIPS creations were technically successful. One left-to-left access was successful but an exaggerated tortuous wire course could not be reduced; a right-to-right access was secured, allowing for successful TIPS creation. Technical considerations for the left-to-left TIPS approach were: small right PV, larger left PV (n = 7); diseased right HV (n = 2); no right PV (n = 2); extra-hepatic right PV (n = 1); right TIPS thrombosis and need for new, parallel TIPS creation (n = 1); no dominant or early arborizing main right PV (n = 4); right liver hepatocellular carcinoma (HCC) (n = 2); right liver HCC + right PV thrombosis (n = 1); cavernous right PV (n = 1); hepatofugal portal venous flow (n = 1); non-specific (n = 1).
Conclusions
Left or middle hepatic to left portal vein TIPS creation is technically feasible. This approach to transhepatic portal decompression is indicated in the appropriate clinical and technical settings