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. 2018 Aug 22;10(8):e3180. doi: 10.7759/cureus.3180

Figure 1. TIPS revision angiogram of a 54-year-old male with heart failure following TIPS placement.

Figure 1

A) Pre-revision shunt angiogram demonstrates a hepatopedal portal venous flow with a widely patent shunt. The portosystemic gradient measured 5 mmHg. B) The first revision layer, a Viabahn stent graft 10 mm x 2.5 cm was deployed within the hepatic venous outflow limb of the Viatorr shunt. The portosystemic gradient increased to 6 mmHg. C) The second revision layer, a Viabahn stent graft 10 mm x 2.5 cm was deployed and positioned flush with the first layer, increasing the portosystemic gradient to 7 mmHg. D) The third revision layer, a Viabahn stent graft 9 mm x 5 cm was deployed and positioned with proximal and distal overlap to create an hourglass shape, increasing the portosystemic gradient to 9 mmHg. E) With the portosystemic gradient goal reached, the final shunt angiogram demonstrates a smooth hourglass shunt narrowing.

TIPS: transjugular intrahepatic portosystemic shunt; Viabahn: WL Gore and Associates, Flagstaff, AZ, USA;Viatorr: WL Gore and Associates, Flagstaff, AZ, USA