Jeanne M. LaBerge, MD, Ernest J. Ring, MD, John R. Lake, MD, Linda D

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Presentation transcript:

Transjugular intrahepatic portosystemic shunts: Preliminary results in 25 patients Jeanne M. LaBerge, MD, Ernest J. Ring, MD, John R. Lake, MD, Linda D. Ferrell, MD, Margaret M. Doherty, RN, Roy L. Gordon, MD, John P. Roberts, MD, Marc Y. Peltzer, MD, Nancy L. Ascher, MD, PhD Journal of Vascular Surgery Volume 16, Issue 2, Pages 258-267 (August 1992) DOI: 10.1016/0741-5214(92)90116-P Copyright © 1992 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 1 36-year-old man with alcoholic liver disease had recurrent variceal bleeding despite prior mesocaval shunt and five prior sclerotherapy sessions. TIPS technique used in this case illustrated above. A, Right hepatic vein was selectively catheterized and hepatic venography was performed. B, A tract was created from the right hepatic vein to a branch of the right portal vein. A 5F catheter was advanced into the main portal vein. C, A Wallstent, deployed across the parenchymal tract, was dilated to 8 mm. Follow-up portal venogram demonstrates prompt flow through the shunt and no flow into varices. Journal of Vascular Surgery 1992 16, 258-267DOI: (10.1016/0741-5214(92)90116-P) Copyright © 1992 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 2 Partial portal diversion after TIPS. A, Portal venogram before TIPS. B, Portal venogram after completion of an 8 mm TIP shunt shows prograde flow into the right and left intrahepatic branches of the portal vein (arrows) as well as flow through the shunt. Journal of Vascular Surgery 1992 16, 258-267DOI: (10.1016/0741-5214(92)90116-P) Copyright © 1992 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 3 Total portal diversion after TIPS. A, Portal venogram before TIPS demonstrates filling of large esophageal varices (arrows).B, After completion of an 8 mm TIPS, flow to varices was eliminated. Intrahepatic portal vein flow is now reversed; the direction of intrahepatic portal flow is now toward the TIPS. Journal of Vascular Surgery 1992 16, 258-267DOI: (10.1016/0741-5214(92)90116-P) Copyright © 1992 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 4 Histologic section. A, Histologic features of tissue at edge of stent stained by Ulex europeaus (which highlights endothelial cells as black line)29 at day 21. Note endothelial staining of surface of pseudointima (top, black line). Underlying connective tissue contains holes where stent wires have been removed (larger white spaces not outlined by solid black line). Tissue surrounding the wire holes is fibrotic, with focal new vessel formation. Residual liver tissue is present below. (Ulex europeaus immunoperoxidase stain; original magnification × 50.) B, Higher magnification of same area shows surface of pseudointima of stent and new vessel formation (endothelial surfaces outlined in black) in the underling organizing connective tissue. Inflammatory cells are also present adjacent to wire holes and scattered throughout connective tissue. (Ulex europeaus immunoperoxidase stain; original magnification × 125; highlighting endothelial cells). Journal of Vascular Surgery 1992 16, 258-267DOI: (10.1016/0741-5214(92)90116-P) Copyright © 1992 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions