ABSTRACT
BACKGROUND: The purpose of this study was to assess the impact of transjugular intrahepatic portosystemic shunting (TIPS) on liver transplantation (LT). METHODS: Seventy-two patients transplanted after TIPS insertion between 1996 and 2008 were compared with 136 matched patients transplanted without prior TIPS. RESULTS: At time of LT, 10% of the TIPS were occluded and 32% were misplaced. Shunt removal was difficult in 17% of the TIPS patients and required vena cava clamping in 10%. Collateral venous circulation was less extensive and intra-operative portocaval anastomosis was required more frequently in the TIPS group. No significant difference in transfusion requirements and operative times were observed between the two groups. Postoperatively, liver and renal function tests, in-hospital stay, graft rejection, re-transplantation and 1-year mortality rates were not statistically different. Ascites volume in the first week was greater in the TIPS group (7.6 L vs 6.9 L, P=0.036). In the TIPS group, ascites and collateral circulation were greater if the shunt was occluded at the time of LT. Shunt misplacement or occlusion was not associated with higher intra-operative or postoperative complication rates. CONCLUSION: TIPS did not impair LT and can provide a safe bridge for LT in the end-stage cirrhotic patients.
Subject(s)
Liver Transplantation , Portasystemic Shunt, Transjugular Intrahepatic , Adult , Ascites/surgery , Case-Control Studies , Collateral Circulation , Female , Gastrointestinal Hemorrhage/surgery , Hepatorenal Syndrome/surgery , Humans , Length of Stay/statistics & numerical data , Liver Circulation , Liver Cirrhosis/surgery , Male , Middle Aged , Portacaval Shunt, Surgical/statistics & numerical data , Retrospective Studies , Young AdultABSTRACT
Authors report a case of a 31 years old patient who eliminate a urinary stone which contains a platinium coil. Five years ago, this patient had a percutaneous nephrolithotomy. A persistent hematuria was successfully managed with angioembolization of a lower polar artery branch. One of the coils was deployed too distally. It was not efficient, it rolled itself up in the pseudoaneurysm cavity. Different physio pathological hypothesis are developed to explain this expulsion.
