Scorpion Portal Vein Access Set

Abstract Purpose To compare the safety and efficacy of left versus right internal jugular vein access for portal vein puncture during transjugular intrahepatic portosystemic shunt (TIPS) creation in patients with a small liver and short vertical puncture distance. Materials and Methods The vertical distance from the hepatic vein orifice to the puncture point of the portal vein was measured by CT and DSA. A distance ≤ 30 mm is defined as a short vertical puncture distance. After 1:1 propensity score matching (PSM), 29 patients of left internal jugular vein-TIPS (LIJ-TIPS) and 29 patients of right internal jugular vein-TIPS (RIJ-TIPS) were included. The number of needle punctures, fluoroscopy time, and radiation dose during the puncture process were statistically analyzed. Results There was no significant difference in the average vertical puncture distances on CT or DSA between LIJ-TIPS and RIJ-TIPS (19.10 ± 0.60 mm vs. 19.30 ± 0.60 mm, P = 0.840; 22.02 ± 0.69 mm vs. 22.23 ± 0.64 mm, P = 0.822, respectively). The average number of needle punctures, fluoroscopy time, and radiation dose in LIJ-TIPS were significantly lower than those in RIJ-TIPS (2.07 ± 0.20 vs. 4.10 ± 0.24, P < 0.001; 78.45 ± 12.80 s vs. 201.16 ± 23.71 s, P < 0.001; 31.55 ± 7.04 mGy vs. 136.69 ± 16.38 mGy, P < 0.001, respectively). Within three punctures, the technical success rate in LIJ-TIPS was significantly higher than that in RIJ-TIPS (86.2 vs. 27.6%, P < 0.001). The incidence of hemoperitoneum in LIJ-TIPS was significantly lower than that in RIJ-TIPS (0% vs. 13.8%, P = 0.038). Conclusion The left internal jugular vein could be used as primary access for TIPS creation in patients with a small liver and short vertical puncture distance.

Download Full-text

Portal Vein Tract Embolization After Percutaneous Transhepatic Biliary Interventions

10.1093/med/9780199986071.003.0087 ◽

2018 ◽

Author(s):

Kazim Narsinh ◽

Steven C. Rose ◽

Thomas Kinney

Keyword(s):

Portal Vein ◽

Hepatic Artery ◽

Arterial Embolization ◽

Bleeding Complications ◽

Hepatic Arteriography ◽

Portal Vein Branch ◽

Vein Access ◽

Suitable Target ◽

Hepatic Artery Branch ◽

Artery Branch

Bleeding complications during percutaneous biliary intervention result from injury to the hepatic artery, hepatic vein, or portal vein. If bleeding originating from a hepatic artery branch is suspected, hepatic arteriography should be performed with and without the drainage catheter in place over a wire, and subselective embolization can be performed if a suitable target is identified. If a bleeding hepatic artery branch is not identified, bleeding from a portal vein branch is suspected. Treatment of portal vein injuries is challenging in this situation because obtaining direct percutaneous portal vein access is ill-advised. Although injuries to the hepatic artery or vein can often be treated by tract tamponade or arterial embolization, iatrogenic communication between the portal vein and biliary system can be difficult to treat effectively. This chapter presents a method to identify portal vein-to-biliary tract communications via cholangiography, with subsequent embolization via the transhepatic tract.

Download Full-text