Type:
Educational Exhibit
Keywords:
Cirrhosis, Shunts, Fluoroscopy, Catheter venography, Catheter arteriography, Liver
Authors:
E. Tang, R. Arya, D. Kim; Boston, MA/US
DOI:
10.1594/ecr2013/C-1929
Learning objectives
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.
2) To illustrate the relevance of portal triad anatomy to targeting of the portal vein by hepatic artery guidewire during TIPS creation.
3) To present outcomes in a 6-year series of TIPS cases at our institution with vs.
without hepatic artery guidewire.