Department of Radiology, Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy.
Diagn Interv Radiol. 2013 Jan-Feb;19(1):61-5. doi: 10.4261/1305-3825.DIR.5541-12.1. Epub 2012 Jun 22.
The aim of this study was to evaluate the feasibility and safety of recanalization of occlusive transjugular intrahepatic portosystemic shunts (TIPS) that are inaccessible to the standard transvenous approach in patients with occlusive bare and covered stents.
From July 1999 to July 2011, 430 consecutive TIPS were performed at a single institution in patients with chronic liver diseases and complications of portal hypertension. During the follow-up, a TIPS occlusion was detected in 20 cases that could not be crossed using a standard transvenous technique with a hydrophilic guidewire.
Five cases had a bare stent, and 15 cases had a covered stent. In 19 cases (95%), the Colapinto needle technique was used. The Colapinto needle was advanced at the mouth of the occluded TIPS (n=2) or within the thrombus in the middle-distal shunt (n=16) to provide aid in advancing the hydrophilic guidewire into the portal vein. In one patient, after failure of the Colapinto technique, the combined transhepatic and transvenous approach was used. All of the procedures were successfully performed without complications.
In patients with occlusive TIPS, stent recanalization is feasible and safe. The Colapinto needle technique should be used as the first approach, reserving the combined transhepatic and transvenous approach only for failure of this technique.
本研究旨在评估对经标准静脉入路无法到达的闭塞性裸支架和覆膜支架经颈静脉肝内门体分流术（TIPS）进行再通的可行性和安全性。
1999 年 7 月至 2011 年 7 月，在一家机构对患有慢性肝脏疾病和门静脉高压并发症的患者进行了 430 例连续 TIPS 治疗。在随访期间，通过标准的亲水导丝经静脉入路发现 20 例 TIPS 闭塞无法通过。
5 例为裸支架，15 例为覆膜支架。19 例（95%）采用 Colapinto 针技术。将 Colapinto 针推进闭塞 TIPS 的开口（n=2）或中远端分流中的血栓内（n=16），以帮助将亲水导丝推进门静脉。在 1 例患者中，在 Colapinto 技术失败后，采用了经肝和经静脉联合入路。所有操作均成功完成，无并发症。
在 TIPS 闭塞患者中，支架再通是可行和安全的。Colapinto 针技术应作为首选方法，仅在该技术失败时才保留经肝和经静脉联合入路。
