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

Transjugular intrahepatic portosystemic shunt has become an accepted intervention to treat sequelae of end-stage liver disease such as refractory ascites and esophageal varices for patients awaiting liver transplantation. Technical difficulties in such patients at the time of transplantation are usually limited to malpositioning of the stent requiring modification of the usual 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 shunt underwent successful liver transplantation complicated by intraoperative migration of the stent into the left pulmonary artery. The stent was removed from the pulmonary artery postoperatively using interventional radiology techniques.