Portal Hypertension

Session: Educational Exhibit Presentations - Station 10: Pediatric Interventions/Portal Hypertension/Practice Development

Tips For Dealing with Unsuccessful TIPS (Transjugular Intrahepatic Portosystemic Shunt): An Image Rich Primer of Procedural Alternatives in the Setting of Unsuccessful TIPS.

Monday, March 6, 2023

5:20 PM – 5:25 PM

Location: Phoenix Convention Center, North Ballroom 120ABC, Poster Hall

Abstract Presenter(s)

Ekramul Gofur, MD

Radiology Resident
Westchester Medical Center

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

FO

Francis J. Oser, MD

Radiology Resident
Temple University Hospital
JP

Joseph Panaro, MD

Clinical Associate Professor, Interventional Radiology
Temple University Hospital
SL

Shane Lee, MD

Interventional Radiology Attending
Temple University Health System
PG

Perry Gerard, MD MBA FACR

Professor, Diagnostic Radiology
Westchester Medical Center
SM

Sam McCabe, MD

Interventional Radiologist
Westchester Medical Center
SM

Shekher Maddineni, MD

Attending
Westchester Medical Center
GR

Grigory Rozenblit, MD

Interventional Radiologist
Westchester Medical Center
JM

Jared Meshekow, MD MPH

Clinical Assistant Professor, Vascular and Interventional Radiology
Temple University Hospital

Disclosure(s):

Ekramul Gofur, MD: No financial relationships to disclose

Learning Objectives:

To discuss procedural alternatives to standard TIPS technique, which may become necessary with unfavorable anatomy and/or portal vein thrombosis.

Background:

With increasing indications and a greater volume of patients meeting the criteria for TIPS procedure, request for TIPS in patients with complex anatomy and pathophysiology has become more common. Indications for TIPS includes the treatment for portal hypertension, refractory ascites, Budd-Chiari syndrome, variceal bleeds and more. Portal vein thrombosis and unfavorable vascular anatomy between the hepatic and portal systems can lead to unsuccessful TIPS through the traditional method. Some alternatives to the standard TIPS procedure include DIPS (direct intrahepatic portosystemic shunt), transplenic access, transvariceal access, and mini-laparotomy with a transmesenteric approach. By obtaining dedicated contrast enhanced preprocedural imaging, interventional radiologists can execute preprocedural planning, and stratify patients to conventional TIPS versus alternative procedures.

Clinical Findings/Procedure Details:

Diagrams, procedural technique, and intraprocedural images will be provided for each of the listed procedures below.

i. Direct intrahepatic portocaval shunt (DIPS)

ii. Transplenic TIPS.

iii. Transvariceal TIPS

iv. Transmesentic TIPS

Conclusion and/or Teaching Points:

The use of TIPS has become more common place with an increasing number of indications, making it vital for medical students, trainees, and early career interventional radiologists to be familiar with alternative/salvage techniques. With the aid of an image rich review, the audience will be able to better understand how these procedures can be performed and what the major steps are under ultrasound and fluoroscopic guidance.