Use of Prolapsing Guidewire to Secure Portal Venous Access During the TIPS Procedure

2018 ◽  
Author(s):  
Thomas Kinney ◽  
Kazim Narsinh
Keyword(s):  
Portal Vein ◽  
Venous Access ◽  
Acute Angle ◽  
Portosystemic Shunt ◽  
Portal System ◽  
Main Portal Vein ◽  
Access Site ◽  
Shunt Procedure ◽  
Intrahepatic Portosystemic Shunt ◽  
Critical Portion

Perhaps the most critical portion of the transjugular intrahepatic portosystemic shunt procedure involves obtaining secure portal venous access. An acute angle of entry into the portal venous system during intrahepatic portosystemic shunt creation can make retrograde advancement of a guidewire into the splenic or superior mesenteric vein difficult. However, securing access from the jugular access site to the portal system with a reliable guidewire is of critical importance during the procedure. This chapter presents a technique to advance a flexible-tip guidewire antegrade into right portal vein branches prior to prolapsing the guidewire into the main portal vein to secure transjugular portal venous access.

scholarly journals Feasibility and Effectiveness of Hepatic Artery Guiding Technique in Transjugular Intrahepatic Portosystemic Shunt Procedure

2020 ◽  
Vol 17 (3) ◽  
Author(s):  
Eung Tae Kim ◽  
Soon-Young Song ◽  
Young Kwon Cho ◽  
Seong Whi Cho
Keyword(s):  
Radiation Dose ◽  
Portal Vein ◽  
Hepatic Artery ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Statistical Significance ◽  
Portosystemic Shunt ◽  
Shunt Procedure ◽  
Intrahepatic Portosystemic Shunt ◽  
The Mean ◽  
Total Procedure

Background: Puncture from the hepatic vein to the portal vein to create a shunt is the most challenging step in transjugular intrahepatic portosystemic shunt (TIPS) procedure Objectives: To evaluate the feasibility and effectiveness of the hepatic artery guiding technique in TIPS procedure. Patients and Methods: From January 2009 to December 2018, 41 patients (36 men, five women; mean age, 57.9 years; range, 33 - 77 years) who underwent TIPS were retrospectively evaluated. Total procedure times, puncture times, and total procedure radiation doses as radiation quantity (mGy) and dose area product (μGym2) from each procedure were compared using the Mann-Whitney U test between those in the simple blind puncture group and those who underwent hepatic artery guiding technique. Results: Technical success was achieved in all patients. Out of 41 patients, simple blind puncture was performed in 11 patients (26.8%), and hepatic artery guiding technique was performed in 30 patients (73.2%). No complications were observed in either group. The mean puncture time among those who underwent hepatic artery guiding technique (26.67 ± 11.46 min) was significantly shorter than the mean puncture time in the simple blind puncture group (38.50 ± 29.69 min) (P = 0.045). There was no statistical significance in total procedure time and radiation dose (P > 0.05). Conclusion: Hepatic artery guiding technique could increase the feasibility of portal vein puncture in TIPS without a significant increase in radiation dose.

scholarly journals TIPS Placement via Combined Transjugular and Transhepatic Approach for Cavernous Portal Vein Occlusion: Targeted Approach

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Natanel Jourabchi ◽  
Justin Pryce McWilliams ◽  
Edward Wolfgang Lee ◽  
Steven Sauk ◽  
Stephen Thomas Kee
Keyword(s):  
Portal Hypertension ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Portal System ◽  
Main Portal Vein ◽  
Vein Thrombosis ◽  
Cavernous Transformation ◽  
Vein Access ◽  
Portal Decompression ◽  
Intrahepatic Portosystemic Shunt

Purpose. We report a novel technique which aided recanalization of an occluded portal vein for transjugular intrahepatic portosystemic shunt (TIPS) creation in a patient with symptomatic portal vein thrombosis with cavernous transformation. Some have previously considered cavernous transformation a contraindication to TIPS.Case Presentation. 62-year-old man with chronic pancreatitis, portal vein thrombosis, portal hypertension and recurrent variceal bleeding presents with melena and hematemesis. The patient was severely anemic, hemodynamically unstable, and required emergent portal decompression. Attempts to recanalize the main portal vein using traditional transjugular access were unsuccessful. After percutaneous transhepatic right portal vein access and navigation of a wire through the occluded main portal vein, an angioplasty balloon was inflated at the desired site of shunt takeoff. The balloon was targeted and punctured from the transjugular approach, and a wire was passed into the portal system. TIPS placement then proceeded routinely.Conclusion. Although occlusion of the portal vein increases difficulty of performing TIPS, it should not be considered an absolute contraindication. We have described a method for recanalizing an occluded portal vein using a combined transhepatic and transjugular approach for TIPS. This approach may be useful to relieve portal hypertension in patients who fail endoscopic and/or surgical therapies.

scholarly journals Transjugular intrahepatic portosystemic stent-shunt as minimally invasive method of portal hypertension correction in multi-disciplinary clinic

2020 ◽  
Vol 25 (4) ◽  
pp. 95-106
Author(s):  
V. M. Durleshter ◽  
S. A. Gabriel’ ◽  
N. V. Korochanskaya ◽  
A. Yu. Buhtoyarov ◽  
P. V. Markov ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Portosystemic Shunt ◽  
Long Term Results ◽  
Portal System ◽  
Post Operative Period ◽  
Shunt Procedure ◽  
Intrahepatic Portosystemic Shunt ◽  
Invasive Method

Aim. Optimization of the tactics of management of patients with liver cirrhosis who underwent Transjugular Intrahepatic Portosystemic Shunt – TIPS based on own experience and literature data. Materials and methods. From 2014 to 2019 years 51 Transjugular Intrahepatic Portosystemic Shunt procedures were performed. Results. The indications for Transjugular Intrahepatic Portosystemic Shunt procedure were detailed. The tactics of treatment in post-operative period was assessed. Shot-term and long-term results of the treatment were discussed. Especial attention was put to persons who included in patient list of liver transplantation. Conclusion. Transjugular Intrahepatic Portosystemic Shunt allows obtaining stable decompression in portal system that reduces frequency of bleeding relapse from gastric and esophageal veins. The mortality was decreased, and patients can wait till liver transplantation.

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