The Pull-Through Technique for Recanalization of Transjugular Intrahepatic Portosystemic Shunt Dysfunction

Figure 1

Patient No. 5 developed shunt dysfunction 18 months after TIPS. Guide wire could not access the shunt via a standard transjugular approach (a); direct puncture stent was performed, and the injected contrast medium confirmed that it reached the shunt (b); a 0.018 guide wire was advanced into RA (black arrow), and a goose-neck snare was used to capture the guide wire and pull it out from the right jugular vein (c); Flex Check-Flo introducer was advanced over the wire to get into the shunt (d); image of balloon dilated shows occlusion at the distal tip (black arrow) (e); an 8 cm covered stent was deployed, and venography shows the patency of the shunt (f).

(a)

(b)

(c)

(d)

(e)

(f)