title: Transjugular intrahepatic portosystemic shunt-related arterial injuries: prospective comparison of large- and small-gauge needle systems.
abstract: OBJECTIVE
  The authors prospectively compared the nature and incidence of hepatic arterial injuries resulting from creation of a transjugular intrahepatic portosystemic shunt (TIPS) with large- and small-gauge needle systems.
  
  
  METHODS
  Fifty patients underwent hepatic and superior mesenteric angiography immediately before and after shunt creation. A sheathed 16-gauge needle system was used to locate and puncture the portal vein in 24 patients. A 21-gauge needle system was used in 26 patients.
  
  
  RESULTS
  Shunts were successfully created in all patients. Three inadvertent hepatic arterial punctures were recognized during shunt placement, two with the small needle and one with the large needle system. No hepatic arterial lesions were detected in any patient. Two incidental hepatomas were identified at angiography.
  
  
  CONCLUSIONS
  TIPS-related hepatic arterial injuries are rare. In this series, large and small needle systems were indistinguishable with respect to this complication.
authors.affiliation: Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104, USA.
authors.forename: Z J
authors.initials: ZJ
authors.lastname: Haskal
authors.forename: C
authors.initials: C
authors.lastname: Cope
authors.forename: R D
authors.initials: RD
authors.lastname: Shlansky-Goldberg
authors.forename: M C
authors.initials: MC
authors.lastname: Soulen
authors.forename: R A
authors.initials: RA
authors.lastname: Baum
authors.forename: D C
authors.initials: DC
authors.lastname: Redd
authors.forename: M J
authors.initials: MJ
authors.lastname: Pentecost
mesh_terms: D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging; D004867:Equipment Design; D005260:Female; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000293:injuries*; D006801:Humans; D015994:Incidence; D007601:Jugular Veins; D008103:Liver Cirrhosis / Q000601:surgery; D008104:Liver Cirrhosis, Alcoholic / Q000601:surgery; D008113:Liver Neoplasms / Q000000981:diagnostic imaging; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging; D008875:Middle Aged; D009339:Needles / Q000009:adverse effects*; D011169:Portal Vein; D011170:Portasystemic Shunt, Surgical / Q000009:adverse effects* / Q000295:instrumentation; D011446:Prospective Studies; D011677:Punctures / Q000295:instrumentation; D013499:Surface Properties