Liver transplantation with simultaneous removal of an intracardiac transjugular intrahepatic portosystemic shunt and a vena cava filter without the utilization of cardiopulmonary bypass

• Published in: Liver transplantation Vol. 11; no. 2; pp. 229 - 232
• Main Authors: Salvalaggio, Paolo R.O., Koffron, Alan J., Fryer, Jonathan P., Abecassis, Michael M.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.02.2005
• Subjects: Adult; Cardiopulmonary Bypass; Comorbidity; Humans; Liver Cirrhosis - epidemiology; Liver Cirrhosis - surgery; Liver Transplantation; Male; Portasystemic Shunt, Transjugular Intrahepatic; Vena Cava Filters; Venous Thrombosis - epidemiology; Venous Thrombosis - therapy
• ISSN: 1527-6465; 1527-6473
• DOI: 10.1002/lt.20292

Transjugular intrahepatic shunts (TIPSs) are widely used in the management of portal hypertension complications including variceal bleeding, refractory ascites, and hepatic hydrothorax. Vena cava filters (VCFs) are an important therapeutic modality in the prevention of pulmonary emboli in patients suffering deep venous thrombosis and clinical contraindications for anticoagulation. Stent and filter misplacement or migration may occur, complicating liver transplantation (LT) surgery. We describe the intraoperative management of a patient with cirrhosis, who had a TIPS extending into the right atrium (RA) and a retrohepatic VCF. Stent and filter removals were deferred until the time of LT. Both procedures were performed successfully by complete cava and portal reconstruction. In conclusion, careful assessment and surgical management of patients with stent and filters permits successful LT. (Liver Transpl 2005;11:229–232.)