Fredrik J. Balldin MD, Presenter: Nothing to Disclose

Jorge Enrique Lopera MD, Abstract Co-Author: Consultant, Boston Scientific Corporation

Ryan R. Scott MD, Abstract Co-Author: Nothing to Disclose

To assess clinical outcomes and examine potential factors leading to hepatic infarction following TIPSS .

A retrospective review of all patients with follow-up cross sectional imaging after TIPSS was performed. The outcomes of patients with imaging findings suggestive of hepatic infarction were analyzed along with technical, demographic, and clinical data.

Out of 62 total patients with cross-sectional imaging after TIPSS performed between 6/2008 and 4/2012, seven (5 males and two females, average age of 54.7 years old (range 44-66)) were identified with imaging (6 CT, 1MRI) suggestive of hepatic infarction. All patients received PTFE stent-grafts. Average pre-TIPSS MELD score was 13.2 (range 6-20) and average post-TIPSS MELD score was 21.2 (range 9-38). Four patients developed worsening liver failure, of which two died early and two received liver transplants. One died of complications related to recurrent upper GI bleeding, one survived with intermittent hepatic encephalopathy, and one patient was lost to follow-up shortly after the procedure. Follow-up imaging reveald 5 patients had thrombosis of right portal vein branches and two had right hepatic vein thrombosis.

Hepatic infarction following TIPSS is a rare complication with high a mortality rate that may be associated with right portal vein and/or hepatic vein thrombosis.

Currently there are only case studies of hepatic infarction after TIPSS. This case series aims to examine causes of this potentially fatal complication while analyzing the outcomes in 7 patients.

Balldin, F, Lopera, J, Scott, R, Hepatic Infarction Following Transjugular Intrahepatic Portosystemic Shunt: An Analysis of Pathogenesis and Clinical Outcomes.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13024407.html