CT-guided transfemoral portocaval shunt creation.
A patient with superior vena cava (SVC) occlusion presented with severe ascites and urgent transjugular intrahepatic portosystemic shunt (TIPS) was requested. The patient had a chronically occluded SVC. An alternative to classic TIPS was employed using CT guidance to traverse the left portal vein to the inferior vena cava with a small gauge needle. Fluoroscopic guidance was then used to snare a wire placed through the needle and then work from the femoral vein to create a portocaval shunt that passed through the caudate lobe. This procedure was a technical success and improved the patient's ascites.
Bloch
R
R
Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, USA. rbloch@u.washington.edu
Fontaine
A
A
Borsa
J
J
Hoffer
E
E
Kowdley
K
K
D001201:Ascites / Q000601:surgery; D005268:Femoral Vein / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D014057:Tomography, X-Ray Computed / Q000295:instrumentation*; D014683:Vena Cava, Superior / Q000000981:diagnostic imaging / Q000601:surgery