Hepatic arterial injury after transjugular intrahepatic portosystemic shunt placement: report of two cases.

Transjugular intrahepatic portosystemic shunts (TIPS) were placed in two patients for treatment of variceal hemorrhage and refractory ascites. In both patients, branches of the right hepatic artery were inadvertently punctured during portal vein localization. In one case, right hepatic artery occlusion resulted in irreversible liver failure. In the other case, intraperitoneal bleeding resulted from the arterial injury. Embolization could not be performed due to celiac axis occlusion. Four days after surgical repair, the patient died of multiorgan failure. Hepatic arterial injuries are a serious complication of TIPS creation. Aggressive efforts to recanalize occlusions and superselective embolization of extravasation are recommended.