Stiffening Cannula Technique Improves Recanalization of TIPS

Researchers report that the use of a stiffening cannula (Cook, Ind. USA) can safely and efficiently recanalize occluded transjugular intrahepatic portosystemic shunts (TIPS) in situations in which conventional lesion crossing is not possible.

Although TIPS has a technical success rate of 95% when performed by experienced operators, dysfunction can occur due to shunt stenosis or occlusion. There are challenges to addressing the stenosis though, with the most difficult part involving introducing the guide wire and catheter into the hepatic venous end of the TIPS and the occlusion crossing. Various strategies have been used to address this issue, and the authors of the current study have proposed using the Rösch-Uchida stiffening cannula to gain access to the hepatic vein.

The investigators retrospectively conducted a single-center, single-arm study on the safety and efficacy of transjugular recanalization of occluded TIPS using the 14G Colapinto stiffening cannula, included in the Rösch -Uchida Transjugular Liver Access Set (Cook, Ind. USA), in cases of failure to cross the occlusion with standard angiographic catheters and balloons.

The study included 15 TIPS revisions that were due to shunt occlusion and that took place between October 2015 and October 2017. Of the 15 patients, 7 were successfully crossed via transjugular access, using standard angiographic catheters. Recanalization with the stiffening cannula was undertaken in the other 8 patients, with a technical success rate of 100% and no complications or periprocedural adverse events.

There was only one case of reocclusion, and this was successfully re-treated with the stiffening cannula technique and stent graft deployment.

The authors wrote that the stiffening cannula technique had advantages compared with other recanalization techniques, including reduced traumatic risk, patient toleration with mild conscious sedation, and the ability to cross the occlusion without dislocating thrombotic material further into the shunt lumen. Although the safety profile of the technique is good, “caution is advised while advancing the stiffening cannula through the SVC, the right atrium and the IVC, especially when a short sheath is used. The use of a long sheath is recommended,” the authors stated.

Reference

 

Spiliopoulos S, Vasiniotis Kamarinos N, Konstantos C, et al. Recanalization of occluded transjugular intrahepatic portosystemic shunts using the Rösch-Uchida stiffening cannula. Cardiovasc Intervent Radiol. 41(5):799-803.