Transhepatic intrajugular portosystemic shunt (TIPS) creation is now established therapy for certain complications of portal hypertension. However, TIPS-related complications can occur, including during its most unpredictable and difficult step, the blind transhepatic puncture of the portal vein, which various methods to improve portal vein targeting have attempted to address. The objectives of this presentation are: 1) To review several methods of portal vein targeting and their advantages/limitations in TIPS creation, particularly the widely-used wedged hepatic venography and the lesser-known hepatic artery guidewire as periportal target....

Overview of TIPS: By relieving portal hypertension, TIPS creation is now an established procedure for prevention of variceal bleeding and treatment of refractory variceal bleeding and refractory ascites, among other complications of portal hypertension [1]. Conventionally, the general steps of the procedure include: 1) Cannulation of the hepatic venous system via percutaneous right internal jugular vein access 2) Measurement of pre-shunt hepatic pressures 3) Visualization of the hepatic/portal venous system, to target shunt placement 4) Transhepatic puncture into the portal venous system from the hepatic...

A total of 10 TIPS placements supervised by a single interventionalist attending operator were performed from 2007-2012. Three cases utilized cWHV to target the portal vein, 6 cases utilized hepatic artery guidewire (HAG) technique, and one utilized both methods. In cases with HAG (Fig. 2 & 3), a 5 Fr vascular sheath was placed with a micropuncture kit in the right common femoral artery and celiac +/- mesenteric angiography with delayed portography phase was performed to visualize the portal venous system.The common hepatic artery was...

During TIPS procedure, portal vein targeting the is most important and difficult step, often the source of complications. Our series, although small in size, demonstrates that portal vein targeting by placement of a microguidewire in the right hepatic artery is safe and largely efficacious and should be considered as a viable alternative to carbon dioxide wedged hepatic venography. Hepatic artery guidewire can be used by operators without carbon dioxide venography capabilities and even by operators for whom TIPS is a less common procedure.

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