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Comment
. 2013 Jun 14;19(22):3528-30.
doi: 10.3748/wjg.v19.i22.3528.

Reducing risk of transjugular intrahepatic portosystemic shunt using ultrasound guided single needle pass

Sum Leong, Hong Kuan Kok, Pradeep Govender, William Torreggiani
Comment

Reducing risk of transjugular intrahepatic portosystemic shunt using ultrasound guided single needle pass

Sum Leong et al. World J Gastroenterol. .

Abstract

Delayed liver laceration following transjugular intrahepatic portosystemic shunt (TIPS) is a serious and likely underdiagnosed complication. It is however an important complication following TIPS, which remains one of the most technically challenging interventional procedures performed. In addition to laceration, a number of complications regarding bleeding and perforation are well described following TIPS procedures. We feel the adoption of techniques such as ours and that of other authors described in the literature using an ultrasound-guided percutaneous transhepatic approach with a small caliber needle provides a safer and less traumatic procedure and should reduce complications of bleeding and almost completely eliminate the risk of liver laceration. Our procedure was successfully performed under conscious sedation rather than general anaesthesia further reducing the overall procedural risk to the patient.

Keywords: Complication; Death; Haemorrhage; Laceration; Liver; Morbidity; Reducing; Transjugular portal systemic shunt; Ultrasound guided.

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Figures

Figure 1
Figure 1
The right portal vein was punctured with a 22-gauge, 20-cm Chiba needle (Cook) close to the bifurcation of the main portal vein, with entry confirmed by aspiration of blood.
Figure 2
Figure 2
A 25-mm diameter Amplatz Gooseneck Snare (ev3 Inc) was used to snare the transhepatic wire, achieving through and through access.
Figure 3
Figure 3
A 0.035-inch, 260-cm long hydrophilic guidewire (Glidewire, Boston Scientific) and 5 Fr Berenstein catheter was then introduced through the transjugular sheath and manipulated into the main portal vein and then into the superior mesenteric vein.
Figure 4
Figure 4
The procedure was completed as conventional transjugular intrahepatic portosystemic shunt with deployment of a 10 mm x 70 mm (Viatorr, WL Gore and Associates) transjugular intrahepatic portosystemic shunt endoprosthesis stent.
See this image and copyright information in PMC

Comment on

References

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