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Semin Intervent Radiol. 2005 Dec;22(4):300-8. doi: 10.1055/s-2005-925556.

The difficult transjugular intrahepatic portosystemic shunt: alternative techniques and "tips" to successful shunt creation.

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Department of Radiology, Rush University Medical Center, Chicago Illinois.


The transjugular intrahepatic portosystemic shunt (TIPS) is one of the most complex procedures performed by interventional radiologists. Most of these procedures are straightforward and may be successfully completed within 2 hours. In some cases, TIPS creation may be extremely difficult, for example in situations such as: variant anatomy, portal vein thrombosis, hepatic vein thrombosis, or preexisting TIPS. In this article we describe some maneuvers that may be attempted in cases where creation of the shunt proves to be difficult.


Transjugular intrahepatic portosystemic shunts; hepatic vein thrombosis; portal hypertension; portal vein thrombosis

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