Transjugular Intrahepatic Portosystemic Shunt Creation in a Polycystic Liver Facilitated by Hybrid Cross-sectional/Angiographic Imaging
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CASE REPORT
Our institutional review board does not require approval for this type of retrospective case report.
A 62-year-old woman with an 18-year history of symptomatic polycystic kidney disease, PCLD, and hypertension presented with progressive abdominal distension, pain, and refractory hypertension. She was functionally anuric and had an operational Brescia-Cimino shunt. The patient underwent elective bilateral radical nephrectomies for relief of bulk symptoms and renovascular contribution to
DISCUSSION
TIPS creation has essentially completely replaced surgical portosystemic shunt creation for treatment of complications of portal hypertension. The original consensus document published by the National Digestive Diseases Advisory Board in 1995 (8) outlined indications and contraindications, but many guidelines were based on skepticism and theoretical risks without scientific evidence. The updated guidelines from the American Association for the Study of Liver Diseases (1) show that some of the
Acknowledgments
The authors thank Mervin Nicolas for outstanding technical support.
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Cited by (34)
Intravascular US Guidance for Direct Intrahepatic Portosystemic Shunt Creation in the Setting of Polycystic Liver Disease
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2017, Diagnostic and Interventional ImagingChapter 87 - Transjugular intrahepatic portosystemic shunting: Indications and technique
2016, Blumgart's Surgery of the Liver, Biliary Tract and Pancreas: Sixth EditionNovel Image Guidance Techniques for Portal Vein Targeting During Transjugular Intrahepatic Portosystemic Shunt Creation
2016, Techniques in Vascular and Interventional RadiologyCitation Excerpt :This has been used to create a TIPS in the setting of polycystic liver disease, previously a contraindication for TIPS creation due to distorted anatomy and the risk of hemorrhage. Cone-beam CT was used in this procedure after an initial pass with a 22-gauge needle to appropriately redirect the needle into the portal vein with a single additional pass30 (Fig. 7). Cone-beam CT has also been used to generate a three-dimensional rotational angiogram from a wedged CO2 portogram, with subsequent overlay of this image during fluoroscopic needle passage to guide the portal vein puncture31 (Fig. 2E).
The instrumentation portion of this project was supported by NIH R01 EB003524, Siemens Medical Solutions, and the Lucas Foundation. N.S. and T.M. are employees of Siemens Medical Solutions. None of the other authors have identified a conflict of interest.