title: Localization of the portal vein for transjugular catheterization: percutaneous placement of a metallic marker with real-time US guidance.
abstract: Transjugular catheterization of the portal vein can be used to form a portosystemic shunt. Conventionally, the passage of a needle from the hepatic vein into the portal vein is performed with fluoroscopic monitoring only. Several methods to target the portal vein have been previously reported, including transhepatic venous catheterization, indirect portography (arterial catheterization), or skin marking based on ultrasound (US) mapping of portal landmarks. The authors used realtime US guidance to percutaneously place a small marking wire in the parenchyma next to the portal bifurcation. A 0.018-inch-diameter, 5-mm-long platinum wire is delivered through a 22-gauge echo-tipped needle placed adjacent to the right portal vein. This marking wire enabled rapid entry into the portal vein, helped avoid extrahepatic puncture, and was useful during stent deployment and positioning.
authors.affiliation: Department of Radiology, Indiana University School of Medicine, Indianapolis 46202-5253.
authors.forename: J T
authors.initials: JT
authors.lastname: Harman
authors.forename: J D
authors.initials: JD
authors.lastname: Reed
authors.forename: K K
authors.initials: KK
authors.lastname: Kopecky
authors.forename: V J
authors.initials: VJ
authors.lastname: Harris
authors.forename: M F
authors.initials: MF
authors.lastname: Haggerty
authors.forename: A S
authors.initials: AS
authors.lastname: Strzembosz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002406:Catheterization, Peripheral / Q000295:instrumentation* / Q000379:methods; D002648:Child; D005260:Female; D006801:Humans; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging*; D011170:Portasystemic Shunt, Surgical / Q000379:methods*; D014463:Ultrasonography