Segmental Liver Ischemia/Infarction after Elective Transjugular Intrahepatic Portosystemic Shunt Creation: Clinical Outcomes in 10 Patients

Jorge E Lopera, Venkata Katabathina, Brian Bosworth, Deepak Garg, Ghazwan Kroma, Andres E Garza-berlanga, Rajeev Suri, Michael Wholey

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Purpose: To determine the clinical significance and potential mechanisms of segmental liver ischemia and infarction following elective creation of a transjugular intrahepatic portosystemic shunt (TIPS). Materials and Methods: A retrospective review of 374 elective TIPS creations between March 2006 and September 2014 was performed, yielding 77 contrast-enhanced scans for review. Patients with imaging evidence of segmental perfusion defects were identified. Model for End-stage Liver Disease scores, liver volume, and percentage of liver ischemia/infarct were calculated. Clinical outcomes after TIPS creation were reviewed. Results: Ten patients showed segmental liver ischemia/infarction on contrast-enhanced imaging after elective TIPS creation. Associated imaging findings included thrombosis of the posterior division (n = 7) and anterior division (n = 3) of the right portal vein (PV). The right hepatic vein was thrombosed in five patients, as was the middle hepatic vein in three and the left hepatic vein in one. One patient had acute thrombosis of the shunt and main PV. Three patients developed acute liver failure: two died within 30 days and one required emergent liver transplantation. One patient died of acute renal failure 20 days after TIPS creation. A large infarct in a transplant recipient resulted in biloma formation. Five patients survived without additional interventions with follow-up times ranging from 3 months to 5 years. Conclusions: Segmental perfusion defects are not an uncommon imaging finding after elective TIPS creation. Segmental ischemia was associated with thrombosis of major branches of the PVs and often of the hepatic veins. Clinical outcomes varied significantly, from transient problems to acute liver failure with high mortality rates.

Original languageEnglish (US)
JournalJournal of Vascular and Interventional Radiology
DOIs
StateAccepted/In press - Aug 7 2014

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Transjugular Intrahepatic Portasystemic Shunt
Infarction
Ischemia
Liver
Hepatic Veins
Thrombosis
Acute Liver Failure
Portal Vein
Perfusion
Budd-Chiari Syndrome
End Stage Liver Disease
Acute Kidney Injury
Liver Transplantation
Mortality

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Segmental Liver Ischemia/Infarction after Elective Transjugular Intrahepatic Portosystemic Shunt Creation : Clinical Outcomes in 10 Patients. / Lopera, Jorge E; Katabathina, Venkata; Bosworth, Brian; Garg, Deepak; Kroma, Ghazwan; Garza-berlanga, Andres E; Suri, Rajeev; Wholey, Michael.

In: Journal of Vascular and Interventional Radiology, 07.08.2014.

Research output: Contribution to journalArticle

Lopera, Jorge E ; Katabathina, Venkata ; Bosworth, Brian ; Garg, Deepak ; Kroma, Ghazwan ; Garza-berlanga, Andres E ; Suri, Rajeev ; Wholey, Michael. / Segmental Liver Ischemia/Infarction after Elective Transjugular Intrahepatic Portosystemic Shunt Creation : Clinical Outcomes in 10 Patients. In: Journal of Vascular and Interventional Radiology. 2014.
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abstract = "Purpose: To determine the clinical significance and potential mechanisms of segmental liver ischemia and infarction following elective creation of a transjugular intrahepatic portosystemic shunt (TIPS). Materials and Methods: A retrospective review of 374 elective TIPS creations between March 2006 and September 2014 was performed, yielding 77 contrast-enhanced scans for review. Patients with imaging evidence of segmental perfusion defects were identified. Model for End-stage Liver Disease scores, liver volume, and percentage of liver ischemia/infarct were calculated. Clinical outcomes after TIPS creation were reviewed. Results: Ten patients showed segmental liver ischemia/infarction on contrast-enhanced imaging after elective TIPS creation. Associated imaging findings included thrombosis of the posterior division (n = 7) and anterior division (n = 3) of the right portal vein (PV). The right hepatic vein was thrombosed in five patients, as was the middle hepatic vein in three and the left hepatic vein in one. One patient had acute thrombosis of the shunt and main PV. Three patients developed acute liver failure: two died within 30 days and one required emergent liver transplantation. One patient died of acute renal failure 20 days after TIPS creation. A large infarct in a transplant recipient resulted in biloma formation. Five patients survived without additional interventions with follow-up times ranging from 3 months to 5 years. Conclusions: Segmental perfusion defects are not an uncommon imaging finding after elective TIPS creation. Segmental ischemia was associated with thrombosis of major branches of the PVs and often of the hepatic veins. Clinical outcomes varied significantly, from transient problems to acute liver failure with high mortality rates.",
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AU - Bosworth, Brian

AU - Garg, Deepak

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AU - Suri, Rajeev

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N2 - Purpose: To determine the clinical significance and potential mechanisms of segmental liver ischemia and infarction following elective creation of a transjugular intrahepatic portosystemic shunt (TIPS). Materials and Methods: A retrospective review of 374 elective TIPS creations between March 2006 and September 2014 was performed, yielding 77 contrast-enhanced scans for review. Patients with imaging evidence of segmental perfusion defects were identified. Model for End-stage Liver Disease scores, liver volume, and percentage of liver ischemia/infarct were calculated. Clinical outcomes after TIPS creation were reviewed. Results: Ten patients showed segmental liver ischemia/infarction on contrast-enhanced imaging after elective TIPS creation. Associated imaging findings included thrombosis of the posterior division (n = 7) and anterior division (n = 3) of the right portal vein (PV). The right hepatic vein was thrombosed in five patients, as was the middle hepatic vein in three and the left hepatic vein in one. One patient had acute thrombosis of the shunt and main PV. Three patients developed acute liver failure: two died within 30 days and one required emergent liver transplantation. One patient died of acute renal failure 20 days after TIPS creation. A large infarct in a transplant recipient resulted in biloma formation. Five patients survived without additional interventions with follow-up times ranging from 3 months to 5 years. Conclusions: Segmental perfusion defects are not an uncommon imaging finding after elective TIPS creation. Segmental ischemia was associated with thrombosis of major branches of the PVs and often of the hepatic veins. Clinical outcomes varied significantly, from transient problems to acute liver failure with high mortality rates.

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