Balloon occlusion versus wedged hepatic venography using carbon dioxide for portal vein opacification during TIPS

Abstract

Balloon occlusion hepatic venography using carbon dioxide (CO2) is proposed as a safer yet simpler alternative to wedged catheter techniques that have caused hepatic lacerations during the transjugular intrahepatic portosystemic shunt (TIPS) procedure. The image quality of CO2 wedged catheter and balloon occlusion venograms was comparable in our small series, with no venographic-related complications occurring in the balloon occlusion group.

Transjugular Intrahepatic Portosystemic Shunt Placement in Liver Transplant Recipients: Experiences with Pediatric and Adult Patients

“…In two cases, we introduced guidewires into the portal vein percutaneously to help guide punctures. Other techniques of portal vein localization can certainly be used, such as CT-guided marking of the portal vein [9], CO 2 wedged hepatic venography [10], or balloon occlusion venography [11]. However, the safety of CO 2 wedged or balloon occlusion hepatic venography in liver transplantation, especially partial transplantation, is not known.…”

Fine-needle percutaneous transhepatic parenchymal portal venography by using carbon dioxide: a pilot study in pigs

“…Various techniques have been reported regarding injections of CO 2 through microcatheter, fine needle, and even between the guide wire and the needle or catheter in different interventional procedures to visualize portal venous anatomy [17,18,19]. Semba et al [20] and Taylor et al [21] reported hepatic laceration and peritoneal extravasation related to the procedure of CO 2 wedged hepatic venography, even with the result of fatality. Generally, it is believed to be a minimally invasive technique because of the very tiny caliber of the fine needle itself.…”

“…Semba et al [20] and Taylor et al [21] reported hepatic laceration and peritoneal extravasation related to the procedure of CO 2 wedged hepatic venography, even with the result of fatality. The direct communication between portal vein and sinusoidal bed provides anatomical access for portal venography [21,25,26].Thirdly, hepatic hemodynamics might play an important role in interacting hepatic circulation and be critical to the visualization of portal vein in CO 2 intraparenchymal portal venography. The likelihood of extravasation or liver laceration could be greatly reduced presumably.…”

CO2 wedged hepatic venography: technical considerations and comparison with direct and indirect portography with iodinated contrast

“…Maybe the fact that a larger amount of liver volume is recruited to allow passage of CO 2 to the portal circulation has some effect in addition to improving image quality. Second, the chances of the catheter becoming inadvertently free, causing air embolism to the right atrium, are reduced [3,13]. Extravasation of CO 2 into the liver parenchyma may be associated with pain and the formation of small fluid-filled cavities visible on US, which are presumably due to hematoma [3].…”