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case_images: Coronal CT image shows thrombotic occlusion of the TIPS shunt and massive splenomegaly. Note hepatic dome hypodense lesion which represents post ablation changes related to a hepatocellular carcinoma.
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case_images: TIPS revision procedures (angioplasty/thrombectomy) to treat in-stent stenoses. This issue stemmed from a lack of preventative anticoagulation, due to the patient's severe spleen-induced thrombocytopenia (Fig. 1).
case_images: DSA images from the TIPS thrombectomy procedure. (A) demonstrates residual thrombus (arrow) in the TIPS shunt after a few passes of suction thrombectomy. Relining the TIPS shunt was successful after thrombectomy, and a stenosis in the hepatic vein just cephalad to the TIPS shunt can be seen (arrows) (B). 10 mm Balloon angioplasty was therefore performed (C). After the procedure, the shunt is widely patent with improved caliber of the hepatocaval junction stenosis (D).
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case_images: Multiple passes were made, and large volume of organized thrombus was removed (Fig. 2A). At this point, a fibrotic stenosis was unmasked at the stent's hepatic venous end (Fig. 2B). Final portal angiogram after 10 mm balloon angioplasty (Fig. 2C) showed a functioning TIPS shunt, though the portosystemic venous gradient remained elevated at 30 mmHg (Fig. 2D).
case_images: 4 days after the TIPS thrombectomy, partial splenic artery embolization was successfully performed with particles and coils to treat hypersplenism (arrows).
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case_images: The PSE was performed via femoral access and involved subselective catheterization of splenic artery branches and embolization with 700-900-micron embosphere (BioSphere Medical S.A.) particles to infarct approximately 50% of the splenic parenchyma (Fig. 3).