Figs 2A to H:

Patient previously treated for massive variceal bleeding with an “Early Tip”. Tips dysfunction after 18 months of follow-up. (A) TIPS placement in a patient with cavernomatosis and previous variceal bleeding; (B) CT scan performed in the follow-up period reported an increased dimension of the cavernomatosis in the hepatic hilum without signs of shunt dysfunction due to artifact for abdominal circumference; (C to E) The phlebography and IVUS examinations showed fibro-lipid layer on the uncovered part of the TIPS, probably caused by flow turbulence generated in the cavernomatous segment of the portal vein (E; arrow), which was subsequently treated with angioplasty with a 10 mm × 40 mm balloon catheter (F); (G, H): Control with phlebography, IVUS and venous pressures reported reduction of the long fibrolipidic apposition (arrow) and pressure values