Liver transplantation complicated by misplaced TIPS in the portal vein

Annals of Surgery
P A ClavienP Suhocki

Abstract

The purpose of this study was to determine the incidence and complications related to transjugular intrahepatic portosystemic shunt (TIPS) stents found in the portal vein at the time of an orthotopic liver transplantation. Transjugular intrahepatic portosystemic shunts are frequently used in patients with end-stage liver disease as a bridge to liver transplantation. The incidence of finding the metal stent outside of the liver parenchyma at the time of transplantation is reported as high as 30%. Most cases that have been detailed involve stents misplaced in the vena cava with various outcomes. Almost no data are available regarding stents misplaced into the portal vein. We report our experience with four patients with whom a TIPS stent was found misplaced in the portal vein at the time of liver transplantation, including one patient with a stent extending into the superior mesenteric vein. This patient required extensive venous reconstruction using a retropancreatic "pant" donor-iliac vein graft. The three other patients were transplanted without the need for extensive venous reconstruction. There was no significant difference in operative times for this group of patients, but there was a significant increase in the requirement...Continue Reading

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