LETTER TO THE EDITOR A Case of Stent Fracture After Transjugular Intrahepatic Portosystemic Shunt Toshiyuki Komaki 1 • Takao Hiraki 1 • Mayu Uka 1 • Hiroyasu Fujiwara 1 • Toshihiro Iguchi 1 • Susumu Kanazawa 1 Received: 20 November 2017 / Accepted: 8 January 2018 Ó Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018 To the Editor, Transjugular intrahepatic portosystemic shunt (TIPS) is effective in decompressing portal hypertension [1]. Although the creation of a TIPS may be accompanied by various complications [1], stent fracture is extremely rare. In this article, we report a case of stent fracture after TIPS creation. Our institutional review board did not require approval to report this study. A 63-year-old man underwent a TIPS procedure for massive ascites and repeated varicose bleeding caused by portal hypertension due to hepatitis B. First, a TIPS was created with a 10-mm-diameter, 80-mm- long covered stent (Niti-S stent, ComVi type; Taewoong Medical, Seoul, Korea). Subsequently, a 10-mm-diameter, 40-mm-long bare metal stent (BMS) (Zilver vascular stent; Cook, Bloomington, IN) was additionally placed in order to cover the hepatocaval junction. The distal portion of the BMS overlapped the covered stent, while its proximal portion of approximately 25 mm protruded into the inferior vena cava (IVC) (Fig. 1A). The final portography demon- strated a patent shunt (Fig. 1A). Portal pressure decreased from 34 to 20 mm Hg. After the procedure, ascites decreased and the patient was transferred to a local hospital on day 2. Computed tomography (CT) images 2 months after the procedure revealed fracture of the stent (Fig. 1B). In detail, the Zilver stent transected into the hepatocaval junction (Fig. 1B). A 30-mm-long stent fragment migrated into the IVC, while its proximal edge protruded into the right atrium. Furthermore, two radiopaque markers at the prox- imal edge of the Zilver stent detached and migrated into the right heart (Fig. 1C). The patient was treated conserva- tively because he was asymptomatic. CT images and color Doppler ultrasound 14 months after the procedure demonstrated neither further stent fracture nor further dis- location of the stent fragment. No symptoms associated with the stent fracture developed for 15 months. To our knowledge, two cases of stent fracture after TIPS creation have been reported. Zabicki et al. [2] reported a case of stent fracture in an atypical angulated TIPS that was created between the left hepatic and left portal vein under CT fluoroscopic guidance with a 10-mm-diameter, 80-mm- long covered stent (Fluency; Bard GmbH/Angiomed, Karlsruhe, Germany) and a 10-mm-diameter, 80-mm-long BMS (E-Luminexx; Bard GmbH/Angiomed, Karlsruhe, Germany). Six months later, the BMS fractured. The authors speculated that high bending stress caused the stent fracture. Ding et al. [3] reported another case of stent fracture. TIPS was first created with an 8-mm-diameter, 60-mm-long BMS (E-Luminexx). Then, an 8-mm-diame- ter, 40-mm-long covered stent (Fluency) as added inside & Takao Hiraki takaoh@tc4.so-net.ne.jp Toshiyuki Komaki me18030@s.okayama-u.ac.jp Mayu Uka mayuka@okayama-u.ac.jp Hiroyasu Fujiwara hirofujiwar@gmail.com Toshihiro Iguchi iguchi@ba2.so-net.ne.jp Susumu Kanazawa susumu@cc.okayama-u.ac.jp 1 Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan 123 Cardiovasc Intervent Radiol https://doi.org/10.1007/s00270-018-1879-2