Recurrent thrombotic occlusion of a transjugular intrahepatic portosystemic stent-shunt due to activated protein C resistance

Table 1 Complications of TIPS

Acute complications	Chronic complications
Transcapsural puncture	Deterioration of liver function
Intrahepatic hematoma	New or worsened hepatic encephalopathy
Intraperitoneal bleed	TIPS dysfunction (thrombosis, stenosis)
Fistulae:	Hyperdynamic circulation and cardiac failure
Hemobilia
Arterio-portal fistulae
Malpuncture of other organs
Portal vein thrombosis
TIPS dislocation
Infections and sepsis
Hemolysis
Contrast media-related complications:
Allergic reactions
Acute renal failure
Cardiac arrhythmias/myocardial infarction

Table 2 Causes of thrombophilia

Hereditary causes	Acquired causes
Resistance to APC = Factor V-Leiden	Antiphospholipid syndrome
(Factor V gene mutation G1691A)	Lupus anticoagulant
Prothrombin gene mutation	Malignancy and myeloproliferative
(G20210A)	disorders
Antithrombin III deficiency	Hyperviscosity (multiple myeloma)
Hyperhomocysteinemia	Cardiac failure and any type of shock
(MTHFR mutation)
Protein C deficiency	Nephrotic syndrome
Protein S deficiency	Liver cirrhosis
Dysfibrinogenemia	Protein-losing enteropathy
Increased factor VIII and PAI-1	Chronic inflammatory bowel disease
Plasminogen deficiency	Hemolytic uremic syndrome
tPA deficiency	Thrombotic thrombocytopenic purpura
	Post-surgery, post-traumatic,
	immobilization
	Oral contraceptives and smoking
	Obesity
	Pregnancy
	Geriatric patients