Chen Si-Liang, Xiao Cheng-Jiang, Wang Shuai, Jin Si-Yi, Zhao Jian-Bo
Department of Interventional Radiology, Guangdong Second Provincial General Hospital, Guangzhou, 510317 Guangdong, China.
Department of Intensive Care Unit, Guangzhou Hospital of Integrated Traditional and West Medicine, Guangzhou, 510800 Guangdong, China.
Gastroenterol Res Pract. 2020 Apr 27;2020:9150173. doi: 10.1155/2020/9150173. eCollection 2020.
To evaluate the technical efficacy and safety of the pull-through technique in recanalization of transjugular intrahepatic portosystemic shunt (TIPS) when standard transjugular approach is inaccessible.
A retrospective review of patients underwent TIPS revision via the pull-through technique was performed. Transhepatic directly punctured stent was conducted if the portal vein could not be accessed via standard transjugular approach. Technical success was defined by recanalization of shunt. Clinical success was defined as bleeding interruption and ascites regression without pharmacological support. All patients were followed up by clinical evaluation and Doppler ultrasound.
Between January 2010 and December 2016, a total of 63 patients underwent TIPS revision, and 14 of them could not be accessed via standard transjugular approaches owing to stenosis or occlusion of the hepatic vein. The pull-through technique was successful in 13 patients, and one patient underwent parallel TIPS. No procedure-related complication was observed. One patient died of liver failure one week after the procedure. During the follow-up, three patients developed hepatic encephalopathy, and one patient developed TIPS dysfunction again and experienced variceal bleeding. The primary patency rate after TIPS revision was 92% (11/12) at 12 months.
The pull-through technique was effective and safe for recanalization of TIPS inaccessible via standard transjugular approach.
评估在标准经颈静脉途径无法实施时，经颈静脉肝内门体分流术（TIPS）再通中牵拉技术的技术疗效和安全性。
对采用牵拉技术进行TIPS翻修的患者进行回顾性研究。如果无法通过标准经颈静脉途径进入门静脉，则行经肝直接穿刺支架置入。分流再通定义为技术成功。临床成功定义为在无药物支持的情况下出血停止且腹水消退。所有患者均通过临床评估和多普勒超声进行随访。
2010年1月至2016年12月期间，共有63例患者接受了TIPS翻修，其中14例因肝静脉狭窄或闭塞无法通过标准经颈静脉途径进入。牵拉技术在13例患者中成功，1例患者接受了并行TIPS。未观察到与手术相关的并发症。1例患者术后1周死于肝功能衰竭。随访期间，3例患者发生肝性脑病，1例患者TIPS功能再次出现障碍并发生静脉曲张出血。TIPS翻修术后12个月的原发性通畅率为92%（11/12）。
对于无法通过标准经颈静脉途径进行再通的TIPS，牵拉技术是有效且安全的。
