|
Complication |
Prevention/management |
|
Carotid artery puncture during internal jugular vein access |
Using ultrasound and fluoroscopic guidance for jugular venous access |
|
Right atrial perforation |
Avoid keeping the large 10-F sheath in the right atrium after the procedure |
|
Capsular laceration during wedged hepatic venography |
Using closed bag system for CO2 delivery/gentle injection of iodinated contrast |
|
Hepatic capsular transgression or extrahepatic portal venous puncture |
Using guidance for portal venous access |
|
Non-target TIPS stent insertion into biliary tract or hepatic artery |
Using guidance (USG/IVUS/CBCT) for portal venous access, confirm successful puncture with contrast injection |
|
TIPS stent migration |
Careful stent deployement and maintaining wire access across the stent until satisfactory, positioning is confirmed with portal venography, in case retrieval is needed |
|
Early shunt occlusion |
Positioning the proximal end of the stent till the hepatico-caval junction; thrombectomy, thrombolysis and restenting can be done for establishing flow |
|
Hernia incarceration |
Pre-TIPS hernia repair; alternatively, keeping a high index of suspicion after TIPS and prompt referral to a surgeon for management |
