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Liver failure complicating segmental hepatic ischaemia induced by a PTFE-coated TIPS stent
  1. F Vizzutti1,2,
  2. U Arena1,
  3. L Rega2,3,
  4. M Zipoli1,
  5. J G Abraldes4,
  6. R G Romanelli1,
  7. R Tarquini1,
  8. G Laffi1,
  9. M Pinzani1,5
  1. 1
    Department of Internal Medicine, University of Florence, Florence, Italy
  2. 2
    Hepatic Hemodynamic Laboratory, University of Florence, Azienda Ospedaliero Universitaria di Careggi, Florence, Italy
  3. 3
    Dipartimento di Fisiopatologia Clinica, Unità di Radiodiagnostica, Azienda Ospedaliero Universitaria di Careggi, Florence, Italy
  4. 4
    Hepatic Hemodynamic Laboratory, Liver Unit, IMDiM, Hospital Clínic, Centro de Investigación Biomédica en red de Enfermedades Hepáticas y Digestivas, University of Barcelona, Spain
  5. 5
    Center for Research, Higher Education and Transfer DENOThe, University of Florence, Florence, Italy
  1. Dr M Pinzani, Dipartimento di Medicina Interna, Viale G.B. Morgagni, 85, 50134 Firenze, Italy; m.pinzani{at}dmi.unifi.it

Abstract

The use of polytetrafluoroethylene (PTFE)-covered prostheses improves trans-jugular intrahepatic porto-systemic shunt (TIPS) patency and decreases the incidence of clinical relapses and re-interventions. Therefore, the improvement provided by covered stents might expand the currently accepted recommendations for TIPS use. Stent-related occlusion of the hepatic vein with consequent ischaemia of the corresponding liver parenchyma emerges as a novel complication reported in at least 5% of patients implanted with coated stents. However, this complication was reported to be mild, without signs or symptoms of liver failure, and self-limiting. We report a case of segmental liver ischaemia following PTFE-covered stent placement resulting in a marked impairment in liver function in a patient with hepatitis C virus cirrhosis implanted because of refractory oesophageal bleeding, thus expanding the severity range of this new procedural complication. Moreover, we discuss the possible involvement of additional pathogenetic mechanisms other than out-flow obstruction in the onset of coated-stent induced congestive liver ischaemia.

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Footnotes

  • Competing interests: None declared.

  • Patient consent: Obtained.

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