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. 2022 Dec 1;95(1140):20220556.
doi: 10.1259/bjr.20220556. Epub 2022 Oct 6.

Modified gun-sight transjugular intrahepatic portosystemic shunt technique

Matthew Lukies  1   2 , Heather Moriarty  1   3 , Tuan Phan  1
Affiliations

Modified gun-sight transjugular intrahepatic portosystemic shunt technique

Matthew Lukies et al. Br J Radiol. .

Abstract

Objectives: Conventional transjugular intrahepatic portosystemic shunt (TIPS) stent insertion is an established procedure with high rates of technical success. However, alternative techniques may increase success rates in the setting of challenging anatomy or limited resources. Originally described as a salvage porto-caval approach, we present a modified gun-sight porto-hepatic TIPS technique.

Methods: A retrospective review was performed identifying patients who underwent modified gun-sight TIPS over a 1-year period. Six procedures were identified, with snares opened in the target hepatic and portal veins, fluoroscopic percutaneous transhepatic puncture through the snares, and wire pulled through-and-through to establish a parenchymal tract. Five modified gun-sight procedures were primary, and one was salvage.

Results: All modified gun-sight TIPS procedures were technically successful with a single needle pass, with patency and appropriate haemodynamic flow at 2 weeks. Advantages of the technique include fluoroscopic-guided transhepatic puncture utilising typically on-shelf low-cost equipment, without requiring a dedicated TIPS set or endovascular ultrasound. Disadvantages include liver capsular puncture.

Conclusions: The modified gun-sight TIPS technique is an alternative approach utilising typically on-shelf and low-cost equipment for a targeted fluoroscopic-guided parenchymal puncture.

Advances in knowledge: The presented technique is an initial description of a novel alternative TIPS technique, which may be useful to consider in challenging cases.

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Figures

Figure 1.
Figure 1.
Concurrent catheter access into the target right portal vein branch and right hepatic vein segment
Figure 2.
Figure 2.
Obliqued uptilt anteroposterior (a) and lateral (b) fluoroscopic views of the gun-sight percutaneous fluoroscopic needle puncture through the fashioned snares in the target right portal vein branch and right hepatic vein segment
Figure 3.
Figure 3.
Snaring of a wire passed through the gun-sight needle to establish through-and-through access across the hepatic parenchyma (a&b)
Figure 4.
Figure 4.
10 Fr sheath access via the right hepatic vein segment into the right portal vein
Figure 5.
Figure 5.
TIPS stent in place
See this image and copyright information in PMC

References

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