Transhepatic puncture of portal and hepatic veins for TIPS using a single-needle pass under sonographic guidance

Abstract

OBJECTIVE. Creating transjugular intrahepatic portosystemic shunts (TIPS) requires accessing a portal vein branch from a metal cannula wedged in a hepatic vein. This initial step in shunt creation often requires multiple blind intrahepatic punctures and occasionally fails. We describe a method using sonographic guidance to serially puncture the portal vein and hepatic vein with a single transhepatic needle pass, after which the TIPS procedure is completed in the standard transjugular fashion. CONCLUSION. Sonographically guided transhepatic dual puncture of the portal and hepatic veins facilitates portosystemic shunt creation in a single needle pass and allows more controlled selection of the portal vein entry and hepatic vein landing sites in selected patients. © American Roentgen Ray Society.