Localization of the Portal Vein for Transjugular Catheterization: Percutaneous Placement of a Metallic Marker with Real-Time US Guidance

TIPS performed in a patient with complete portal vein thrombosis

“…Transjugular wedge hepatic carbon dioxide portography, direct transhepatic puncture and opacification of portal vein, indirect arterial portography during the portal venous phase from an angiogram of the superior mesenteric artery, catheterization of the paraumbilical vein and access to the portal vein [3], or splenoportography may not be very helpful to localize portal vein when portal vein is completely thrombosed. However, placement of guidewire in the right hepatic artery at the porta hepatis via celiac artery approach [4], transhepatic computed tomography (CT)/ultrasound (USG) guided placement of fiducial markers in the thrombus can assist in targeting portal vein via hepatic vein [5], [6]. Percutaneous transhepatic CT/USG guided puncture of hepatic vein through the portal vein, and subsequent snaring of the wire through the transjugular route has been described [5], [7].…”

Percutaneous transjugular intrahepatic stent shunt for treatment of intractable varicose bleeding in paediatric patients

“…If necessary, secondary dilatation of the stent may be performed. Until now, only two reports have described successful TIPSS procedures in young patients (< 12 years old) who suffer from complicated portal hypertension: one 5-yearold [9], and one 8-year-old [3].…”

“…Upper gastro-intestinal bleeding due to varix rupture is a life-threatening event in children with intrahepatic portal hypertension [3,[10][11][12]. Their prognosis has improved since the advent of paediatric endoscopic sclerotherapy, by which bleeding is controlled in 90% of patients [10,12]; however, some patients fail to respond to this therapy and need emergency orthotopic liver transplantation.…”

A new coaxial needle system, hepatic artery targeting wire, and biplane fluoroscopy to increase safety and efficacy of TIPS

“…To improve the safety of the portal vein puncture further, Teitelbaum et al [9] inserted a 0.018-inch guidewire into the portal vein and Harman et al [10] placed a microcoil in the portal vein as a target. However, these methods are time consuming and may introduce additional complications.…”