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Peer-reviewedCC BYCureus

Clot Out, Flow Back: Large-Bore Aspiration Thrombectomy for Symptomatic Early Transjugular Intrahepatic Portosystemic Shunt (TIPS) Occlusion.

  • Renato Abu Hana1
  • Ryosuke Miyauchi1
  • Yusuf Alzoubi2
  • Grit A Adler1
  • Vinicius Adami Vayego Fornazari1
  1. 1Radiology, University of Florida College of Medicine - Jacksonville, Jacksonville, USA.
  2. 2Internal Medicine, HCA Florida Blake Hospital, Bradenton, USA.
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Abstract

Thrombotic occlusion of a transjugular intrahepatic portosystemic shunt (TIPS) returns the patient to the portal-hypertensive state prior to shunt creation and requires early recognition and intervention. We describe a 45-year-old woman with metabolic dysfunction-associated steatohepatitis (MASH) cirrhosis who underwent TIPS placement for refractory ascites with subsequent clinical improvement. Approximately two months later, she presented with progressive anasarca, bilateral lower-extremity edema, abdominal distension, and diffuse abdominal pain. Computed tomography (CT) and Doppler ultrasound demonstrated complete in-stent shunt thrombosis, cirrhotic morphology, and moderate ascites. She was started on therapeutic heparin and underwent transjugular TIPS recanalization with large-bore mechanical aspiration thrombectomy followed by balloon angioplasty directed at the hepatic venous outflow segment. Completion venography demonstrated restored flow through the shunt without residual stenosis or obstruction; the portosystemic pressure gradient decreased from 21 to 13 mmHg. Her abdominal pain and manifestations of volume overload improved, and she was discharged on apixaban. This case demonstrates that single-session large-bore aspiration thrombectomy combined with balloon angioplasty can achieve technical, hemodynamic, and early clinical success in symptomatic early TIPS occlusion. Further studies are needed to determine its long-term efficacy and optimal role in TIPS revision.

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Cite

BibTeXRIS
BibTeX
@article{hana2026clot,
  title = {{Clot Out, Flow Back: Large-Bore Aspiration Thrombectomy for Symptomatic Early Transjugular Intrahepatic Portosystemic Shunt (TIPS) Occlusion.}},
  author = {Renato Abu Hana and Ryosuke Miyauchi and Yusuf Alzoubi and Grit A Adler and Vinicius Adami Vayego Fornazari},
  journal = {Cureus},
  year = {2026},
  month = sep,
  doi = {10.7759/cureus.116837},
  url = {https://europepmc.org/article/MED/42927397},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Clot Out, Flow Back: Large-Bore Aspiration Thrombectomy for Symptomatic Early Transjugular Intrahepatic Portosystemic Shunt (TIPS) Occlusion.
AU  - Renato Abu Hana
AU  - Ryosuke Miyauchi
AU  - Yusuf Alzoubi
AU  - Grit A Adler
AU  - Vinicius Adami Vayego Fornazari
PY  - 2026
DA  - 2026/09/24
JO  - Cureus
DO  - 10.7759/cureus.116837
UR  - https://europepmc.org/article/MED/42927397
AB  - Thrombotic occlusion of a transjugular intrahepatic portosystemic shunt (TIPS) returns the patient to the portal-hypertensive state prior to shunt creation and requires early recognition and intervention. We describe a 45-year-old woman with metabolic dysfunction-associated steatohepatitis (MASH) cirrhosis who underwent TIPS placement for refractory ascites with subsequent clinical improvement. Approximately two months later, she presented with progressive anasarca, bilateral lower-extremity edema, abdominal distension, and diffuse abdominal pain. Computed tomography (CT) and Doppler ultrasound demonstrated complete in-stent shunt thrombosis, cirrhotic morphology, and moderate ascites. She was started on therapeutic heparin and underwent transjugular TIPS recanalization with large-bore mechanical aspiration thrombectomy followed by balloon angioplasty directed at the hepatic venous outflow segment. Completion venography demonstrated restored flow through the shunt without residual stenosis or obstruction; the portosystemic pressure gradient decreased from 21 to 13 mmHg. Her abdominal pain and manifestations of volume overload improved, and she was discharged on apixaban. This case demonstrates that single-session large-bore aspiration thrombectomy combined with balloon angioplasty can achieve technical, hemodynamic, and early clinical success in symptomatic early TIPS occlusion. Further studies are needed to determine its long-term efficacy and optimal role in TIPS revision.
SN  - 2168-8184
ER  -