Interventional Radiology - Technical Note
Ultrasound assisted thrombolysis of an occluded transjugular portosystemic shunt
Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
Diagn Interv Radiol ; : -
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Transjugular portosystemic shunt (TIPS) insertion is commonly performed for refractory ascites or variceal bleeding. However, TIPS dysfunction can be seen in both early and late settings, with shunt thrombosis a particular problem. Treatment of shunt dysfunction commonly involves angioplasty and re-lining, with or without embolectomy, mechanical thrombectomy or thrombolysis. Ultrasound assisted thrombolysis has been shown to be successful for treatment of pulmonary embolism, deep vein thrombosis and peripheral arterial thromboembolism, but has not been described before for TIPS occlusion. Ultrasound is theorised to lead to a shortened duration of thrombolysis due to thinning of the fibrin clot and exposing plasminogen receptor sites. In this technical report we describe the first published use of ultrasound assisted thrombolysis in the de-clotting of an occluded TIPS. We found that the use of ultrasound assisted thrombolysis allowed a relatively short duration of thrombolytic therapy, with removal of thrombus extending into the portal vein, facilitating stent re-lining. No complications were observed, in particular no bleeding complications. The TIPS remains patent at 8 months post procedure.