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Transjugular Intrahepatic Portosystemic Shunt Placement in Liver Transplant Recipients: Experiences with Pediatric and Adult Patients

Thuong G. Van Ha1, Brian S. Funaki1, Jonathan Ehrhardt2, Jonathan Lorenz1, David Cronin3, J. Michael Millis3 and Jeffrey Leef1

1 Department of Radiology, The University of Chicago Hospitals, 5841 S. Maryland Ave., MC 2026, Chicago, IL 60637.
2 Pritzker School of Medicine, The University of Chicago Hospitals, Chicago, IL 60637.
3 Department of Surgery, The University of Chicago Hospitals, Chicago, IL 60637.



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  		Fig. 1. —45-year-old female liver transplant recipient who underwent TIPS for ascites. Portal venogram shows metallic stent (solid arrows) in inferior vena cava placed previously for caval stenosis at surgical anastomosis. Puncture is made from transplanted liver right hepatic vein into right portal vein (open arrow), which is opacified with contrast material. Wire (arrowheads) was placed percutaneously in portal vein under sonographic guidance to help guide transhepatic puncture from hepatic vein.

 


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  		Fig. 2A. —16-year-old girl with left lateral segment transplant undergoing evaluation for TIPS placement. Unenhanced CT scans from superior (A) to inferior (D) show relative position of hepatic vein (solid arrows, A) to portal vein (open arrows, C and D). Arrowhead (B) indicates junction of hepatic vein with inferior vena cava (curved arrow, B).

 


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  		Fig. 2B. —16-year-old girl with left lateral segment transplant undergoing evaluation for TIPS placement. Unenhanced CT scans from superior (A) to inferior (D) show relative position of hepatic vein (solid arrows, A) to portal vein (open arrows, C and D). Arrowhead (B) indicates junction of hepatic vein with inferior vena cava (curved arrow, B).

 


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  		Fig. 2C. —16-year-old girl with left lateral segment transplant undergoing evaluation for TIPS placement. Unenhanced CT scans from superior (A) to inferior (D) show relative position of hepatic vein (solid arrows, A) to portal vein (open arrows, C and D). Arrowhead (B) indicates junction of hepatic vein with inferior vena cava (curved arrow, B).

 


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  		Fig. 2D. —16-year-old girl with left lateral segment transplant undergoing evaluation for TIPS placement. Unenhanced CT scans from superior (A) to inferior (D) show relative position of hepatic vein (solid arrows, A) to portal vein (open arrows, C and D). Arrowhead (B) indicates junction of hepatic vein with inferior vena cava (curved arrow, B).

 


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  		Fig. 2E. —16-year-old girl with left lateral segment transplant undergoing evaluation for TIPS placement. Hepatic venogram shows that hepatic vein is accessed and opacified with contrast material (arrows). Stent (arrowheads) is from previous attempt at TIPS placement at different institution. TIPS was placed after CT scans A–D.

 


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  		Fig. 2F. —16-year-old girl with left lateral segment transplant undergoing evaluation for TIPS placement. Portal venogram shows that portal vein is accessed from hepatic vein. Portal vein is opacified (arrows).

 


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  		Fig. 2G. —16-year-old girl with left lateral segment transplant undergoing evaluation for TIPS placement. Shuntogram shows that TIPS shunt is in place (arrows) and is patent as seen by flow of contrast material.

 

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