Wedged Hepatic Venography for Targeting the Portal Vein During TIPS: Comparison of Carbon Dioxide and Iodinated Contrast Agents

Krajina, Antonı́n; Lojík, Miroslav; Chovanec, Vendelı́n; Raupach, Jan; Hůlek, P

doi:10.1007/s00270-001-0096-5

Cited by 42 publications

(22 citation statements)

References 24 publications

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“…TIPS creation is typically completed in a single-plane angiography suite with adjunctive wedge carbon dioxide portography to identify catheter position in relation to the right portal vein (8,9). Attempts have been made to improve visualization and reduce radiation exposure during the procedure, including the use of biplanar angiography (10); guide wire placement targeting the hepatic artery (11), computed tomography (CT)-guided direct percutaneous transhepatic puncture of the left portal vein through a snare placed in the left hepatic vein (12,13); and the "gun-sight" technique, which involves transhepatic needle puncture through two snares, one placed in the right portal vein with CT guidance and the other placed in the retrohepatic IVC (14).…”

mentioning

confidence: 99%

Intravascular Ultrasound in the Creation of Transhepatic Portosystemic Shunts Reduces Needle Passes, Radiation Dose, and Procedure Time: A Retrospective Study of a Single-Institution Experience

Kao

Morshedi

Narsinh

et al. 2016

Journal of Vascular and Interventional Radiology

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mentioning

confidence: 99%

Intravascular Ultrasound in the Creation of Transhepatic Portosystemic Shunts Reduces Needle Passes, Radiation Dose, and Procedure Time: A Retrospective Study of a Single-Institution Experience

Kao

Morshedi

Narsinh

et al. 2016

Journal of Vascular and Interventional Radiology

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“…The position and patency of the portal vein are then confirmed by wedging a catheter into the hepatic vein and injecting carbon dioxide as a contrast medium to opacify the portal vein retrogradely. The reported rate of success in the visualisation of the portal vein with wedged hepatic venography is 87-91% [2,5,6]. Ideally, this rate could be improved.…”

Section: Discussionmentioning

confidence: 99%

“…Of the several steps in the TIPS procedure, transvenous access to the portal vein is by far the most crucial and, unfortunately, also the most unpredictable [4,5]. Attempts have been made to make this blind puncture more targeted in order to shorten the procedure time and enhance its safety.…”

Section: Discussionmentioning

confidence: 99%

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Hepatic artery-targeting guidewire technique during transjugular intrahepatic portosystemic shunt

Yamagami

Tanaka²,

Yoshimatsu³

et al. 2011

BJR

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Objective: This study evaluated the feasibility and safety of the transjugular intrahepatic portosystemic shunt (TIPS) procedure using the hepatic artery-targeting guidewire technique for the puncture step. Methods: We retrospectively reviewed 11 consecutive patients (5 men and 6 women, aged 46-76 years (mean 64 years)) with portal hypertension in whom the TIPS procedure was performed. As the first step in the TIPS procedure in all cases, a micro-guidewire was inserted into the hepatic arterial branch accompanying the portal venous branch through a microcatheter coaxially advanced from a 5-French catheter positioned in the coeliac or common hepatic artery. At the puncture step, the tip of the metallic cannula was aimed 1 cm posterior to the distal part of this micro-guidewire, after which the TIPS procedure was performed. Success rate, number of punctures and complications were evaluated. Results: The TIPS procedure was successfully performed in all 11 patients. The mean number of punctures until success in entering the targeted portal venous branch was 5 (range 1-14). In 3 patients (27%), the right portal venous branch was entered at the first puncture attempt. The hepatic artery was punctured once in one patient and the bile duct was punctured once in another patient. No serious procedure-induced complications occurred. Conclusion: The TIPS procedure can be accomplished safely, precisely and relatively easily using the hepatic artery-targeting guidewire technique. [2,3]. In many institutions, including ours, however, this procedure is rarely performed and it might be difficult to maintain the necessary skills.During the TIPS procedure, the puncture from the proximal portion of the hepatic vein (usually a right hepatic vein) to the proximal portion of a branch of the intrahepatic portal vein (usually the right portal vein) is the most important and difficult step [1,2]. In 1994, Matsui et al [4] introduced a simple technique to assist in this puncture step. This technique was aided by a targeting guidewire in the hepatic arterial branch accompanying the portal venous branch to be punctured. To our knowledge, there has been no subsequent literature on the use of this simple technique, which we have adopted in our institution. This study evaluated the application of the hepatic artery-targeting guidewire technique for the puncture step of the TIPS procedure. We also assessed the occurrence of procedure-induced complications in order to clarify the value of this technique to inexperienced or infrequent operators such as those in our institution. Methods and materials PatientsBetween January 2004 and July 2009, 11 consecutive patients (5 men and 6 women aged 46-76 years (mean 64 years)) with portal hypertension underwent the TIPS procedure at our institution. For these patients, the hepatic artery-targeting guidewire technique was utilised for the puncture step of the TIPS procedure. ProceduresAll procedures were performed after the patient provided written informed consent. The consent form included permission fo...

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“…Mesenteric portovenography, a usually indirect technique depicting the portal system anatomy, can clarify CAPV abnormality and extrahepatic shunts. In recent years, CO 2 -wedged venography is considered a good and safe technique for demonstrating the portal circulation [107] . It has such advantages over indirect portography obtained during visceral arteriography [108] as only a venous puncture is required, free and wedged pressure measurements can be obtained with no iodinated contrast medium injected, and transvenous liver biopsy can be made at the same time.…”

Section: Imageologymentioning

confidence: 99%

Insight into congenital absence of the portal vein: Is it rare?

Shen

Zhu²

2008

WJG

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Wedged Hepatic Venography for Targeting the Portal Vein During TIPS: Comparison of Carbon Dioxide and Iodinated Contrast Agents

Cited by 42 publications

References 24 publications

Intravascular Ultrasound in the Creation of Transhepatic Portosystemic Shunts Reduces Needle Passes, Radiation Dose, and Procedure Time: A Retrospective Study of a Single-Institution Experience

Intravascular Ultrasound in the Creation of Transhepatic Portosystemic Shunts Reduces Needle Passes, Radiation Dose, and Procedure Time: A Retrospective Study of a Single-Institution Experience

Hepatic artery-targeting guidewire technique during transjugular intrahepatic portosystemic shunt

Insight into congenital absence of the portal vein: Is it rare?

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