Acute transjugular intrahepatic portosystemic shunt migration into pulmonary artery during liver transplantation

Transjugular intrahepatic portosystemic shunt has become an accepted interv ention to treat sequelae of end-stage liver disease such as refractory asci tes and esophageal varices for patients awaiting liver transplantation. Tec hnical difficulties in such patients at the time of transplantation are usu ally limited to malpositioning of the stent requiring modification of the u sual vascular anastomoses. Migration of the stent intraoperatively has not been a reported complication in the literature. We report a case in which a patient with a previously placed transjugular intrahepatic portosystemic s hunt underwent successful liver transplantation complicated by intraoperati ve migration of the stent into the left pulmonary artery. The stent was rem oved from the pulmonary artery postoperatively using interventional radiolo gy techniques.