Figure 1. Early shunt dysfunction associated with severe hepatic vein stenosis. (a) Transfemoral selective venogram. 5 F Simmons catheter. Tight stricture of the hepatic vein proximal to the TIPSS Wallstent and near occlusion of the stent shunt lumen. (b)Transjugular recanalization of the blocked shunt. The distal introducer sheath marker is at the lower end of the Wallstent. Just above this is a small tip marker at the end of the device catheter. The ring marking the caudal margin of the graft is just above the midpoint of the Wallstent. The uncovered distal segment lies between the ring and the tip markers. The introducer sheath and device catheter were inserted a further 2 cm prior to sheath withdrawal and stent-graft deployment 1 cm distal to the end of the Wallstent. (c) Post-deployment image showing restoration of the lumen of the shunt. The proximal marker on the Viatorr stent-graft is visible at the junction of the hepatic vein with the inferior vena cava.
Figure 2. Viatorr endoprosthesis for TIPSS (images provided by WL Gore Inc). The three diameters available (12 mm, 10 mm and 8 mm) are demonstrated. Note the ring marker visible through the graft material immediately above the uncovered segment.
Figure 3. Primary TIPSS procedure. (a) A 10 F transjugular sheath lies in the right hepatic vein. A 5 F marker or calibration catheter has been inserted, which enabled measurement of the length of the intrahepatic track and the vein between the track and the inferior vena cava. (b) Post-deployment image after insertion of a 10 mm x 60 (+20) mm Viatorr device.
