Recurrent urinary conduit bleeding in a patient with portal hypertension: Management with a transjugular intrahepatic portosystemic shunt

Objective. To determine if a transjugular intrahepatic portosystemic shunt can control recurrent urinary conduit bleeding in a patient with portal hypertension. Methods. Following transjugular catheterization of the right hepatic vein, a long curve Colapinto needle was advanced through the liver parenchyma into the portal vein near its bifurcation. After a guide wire exchange, a catheter was advanced into the portal system and venogram was obtained. Following another guide wire exchange, a balloon angioplasty catheter was used to create the shunt by dilating the parenchymal tract between the hepatic and portal veins. A self-expandable stent was used to ensure patency of the shunt. Results. After shunt placement, bleeding from the ileal conduit and stoma decreased significantly. A duplex ultrasound at five-month follow-up demonstrated the shunt to be completely patent. Conclusions. Based on this limited experience, it appears that the transjugular, intrahepatic, portosystemic shunt is an acceptable method to control massive, recurrent urinary conduit bleeding in patients with portal hypertension.