Aim: To evaluate the efficacy of intravascular ultrasound (IVUS) in transjugular intrahepatic portosystemic shunt (TIPS) revision associated with phlebography and invasive pressure measurement in patients with clinical or radiological signs of TIPS malfunction. Background: Four patients underwent TIPS revision between February and August 2021. Right internal jugular vein access was achieved under ultrasonographic guidance, a catheter was advanced to achieve the Inferior Vena Cava (IVC) and afterward the Portal vein through the TIPS. Once the Portal vein was achieved, a phlebography was performed, followed by invasive pressure measurement and IVUS exam over the guidewire. Based on the combination of phlebography, invasive pressure measurement, and IVUS evaluations, TIPS dysfunction was treated either with angioplasty or stent apposition. Case description: In all patients, we obtained the reduction of porto-systemic gradient. In three patients, angioplasty with a 10 mm diameter balloon catheter was performed. Anticoagulation therapy was added to one patient. In one patient, the Viatorr's proximal extremity in the suprahepatic vein wall was dislocated, so it was lengthened with a "Viabahn" covered stent. None of the patients developed hepatic encephalopathy after both TIPS placement and TIPS revision. No complications related to the procedure were observed during the follow-up. Clinical improvement in the immediate follow-up period was observed in all patients. In two patients, the abdominal ascites resolved. In another one, the abdominal pain disappeared, and a reduction of the longitudinal spleen diameter was recorded at 3 months follow-up. Conclusion: The use of IVUS allowed us to correctly visualize the organic cause of TIPS malfunction and to obtain direct visualization of the results of endovascular treatment. How to cite this article: Morosetti D, Lenci I, Argirò R, et al. Use of Intravascular Ultrasound to Improve Diagnosis and Treatment of Transjugular Intrahepatic Portosystemic Shunt Dysfunction in Patients in the Long-term Follow-up. Euroasian J Hepato-Gastroenterol 2022;12(1):50-56.

Morosetti, D., Lenci, I., Argirò, R., Milana, M., Gasparrini, F., Crociati, S., et al. (2022). Use of Intravascular Ultrasound to Improve Diagnosis and Treatment of Transjugular Intrahepatic Portosystemic Shunt Dysfunction in Patients in the Long-term Follow-up, 12(1), 50-56 [10.5005/jp-journals-10018-1374].

Use of Intravascular Ultrasound to Improve Diagnosis and Treatment of Transjugular Intrahepatic Portosystemic Shunt Dysfunction in Patients in the Long-term Follow-up

Morosetti, Daniele;Lenci, Ilaria;Milana, Martina;Tisone, Giuseppe;Floris, Roberto;Baiocchi, Leonardo
2022-01-01

Abstract

Aim: To evaluate the efficacy of intravascular ultrasound (IVUS) in transjugular intrahepatic portosystemic shunt (TIPS) revision associated with phlebography and invasive pressure measurement in patients with clinical or radiological signs of TIPS malfunction. Background: Four patients underwent TIPS revision between February and August 2021. Right internal jugular vein access was achieved under ultrasonographic guidance, a catheter was advanced to achieve the Inferior Vena Cava (IVC) and afterward the Portal vein through the TIPS. Once the Portal vein was achieved, a phlebography was performed, followed by invasive pressure measurement and IVUS exam over the guidewire. Based on the combination of phlebography, invasive pressure measurement, and IVUS evaluations, TIPS dysfunction was treated either with angioplasty or stent apposition. Case description: In all patients, we obtained the reduction of porto-systemic gradient. In three patients, angioplasty with a 10 mm diameter balloon catheter was performed. Anticoagulation therapy was added to one patient. In one patient, the Viatorr's proximal extremity in the suprahepatic vein wall was dislocated, so it was lengthened with a "Viabahn" covered stent. None of the patients developed hepatic encephalopathy after both TIPS placement and TIPS revision. No complications related to the procedure were observed during the follow-up. Clinical improvement in the immediate follow-up period was observed in all patients. In two patients, the abdominal ascites resolved. In another one, the abdominal pain disappeared, and a reduction of the longitudinal spleen diameter was recorded at 3 months follow-up. Conclusion: The use of IVUS allowed us to correctly visualize the organic cause of TIPS malfunction and to obtain direct visualization of the results of endovascular treatment. How to cite this article: Morosetti D, Lenci I, Argirò R, et al. Use of Intravascular Ultrasound to Improve Diagnosis and Treatment of Transjugular Intrahepatic Portosystemic Shunt Dysfunction in Patients in the Long-term Follow-up. Euroasian J Hepato-Gastroenterol 2022;12(1):50-56.
Pubblicato
Rilevanza internazionale
Articolo
Esperti anonimi
Settore MED/12
English
Intravascular ultrasound
Transjugular intrahepatic portosystemic shunt dysfunction
Transjugular intrahepatic portosystemic shunt revision
Morosetti, D., Lenci, I., Argirò, R., Milana, M., Gasparrini, F., Crociati, S., et al. (2022). Use of Intravascular Ultrasound to Improve Diagnosis and Treatment of Transjugular Intrahepatic Portosystemic Shunt Dysfunction in Patients in the Long-term Follow-up, 12(1), 50-56 [10.5005/jp-journals-10018-1374].
Morosetti, D; Lenci, I; Argirò, R; Milana, M; Gasparrini, F; Crociati, S; Tisone, G; Floris, R; Baiocchi, L
Articolo su rivista
File in questo prodotto:
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2108/312553
Citazioni
  • ???jsp.display-item.citation.pmc??? 0
  • Scopus ND
  • ???jsp.display-item.citation.isi??? 22
social impact