#tipsprocedure

[appliedinterventionalradiology]

DIPS in a complex patient with cirrhosis and gastric cancer with liver metastases. Patient had massive medication refractory ascites resulting in severe hypotension and renal malperfusion with subsequent renal failure. Ascites was proven non-malignant. TIPS from the right or middle hepatic veins was precluded by intervening tumors. TIPS was attempted from the left hepatic vein but because of uncorrectable hypovolemia the small size and tortuous origin of the left hepatic vein did not enable a stable platform and capsular perforation occurred (image 3). A DIPS was then performed. IVUS did not provide adequate visualization of the portal vein. The course of puncture was determined by review of cross-sectional Imaging (image 4). A curved needle was used to puncture through the wall of the IVC into the caudate branch of the portal vein. The tract was shorter than the shortest available Viabahn stent so a 4cm balloon expandable Atrium stent was deployed but failed to reverse flow or improve the gradient (image 9). A 5cm Viabahn was then deployed which resulted in an excellent result (final image 10). #appliedir #appliedinterventionalradiology #interventionalradiology #withoutascalpel #cirrhosis #ascites #gastriccancer #TIPSprocedure #DIPSprocedure #portalhypertension #gastroenterology #hepatology https://www.instagram.com/p/Bug_fhAntUE/?utm_source=ig_tumblr_share&igshid=1shqyc4uwfg18