Patient Information:
• 44 year-old Male
• PMHx:
–Coronary Artery Disease (2012 DES to LCX, 2017 DES x2 to LAD, 2024 DES to Proximal LAD and Balloon Angioplasty of mid LAD and RCA)
–NSTEMI (January 2024)
–Non-alcoholic steatohepatitis (NASH), Portal Vein Occlusion, Ulcerative Colitis, Hypertension, Hyperlipidemia, Type-2
Diabetes
• PSHx:
–EGDs (with esophageal variceal banding)
• FMHx: Non-contributory
• Social Hx: Non-contributory

Case/Course Description:
• Presented from OSH with angina for coronary cath
• Severe 2v disease not amenable to PCI
• While awaiting CABG, had acute esophageal GI Bleed
• EGD w/ Banding (x2)
• TIPS performed to optimize prior to CABG
• Post-operative TIPS course complicated by NSTEMI
• CABG
• Living donor liver transplant

Discussion:
• This is the most compressed timeline of TIPS, CABG, and LDLT from our literature review
• No case reports of acute coronary syndrome following TIPS while awaiting liver transplant
• Multi-disciplinary IR, CT Surgery, Anesthesia, Hepatology, Transplant surgery discussion regarding timing of interventions
• Several pre-existing case series comparing simultaneous vs staged cardiac + liver transplant surgery
• No clear recommendations on coronary vascularization before liver transplantation
• Anti-coagulation and resuscitation management both intra-operatively and post-operatively
• Specific focus assessing cardiac function and end-organ perfusion during IVC partial clamping and liver reperfusion