title: Portacaval shunt creation using the percutaneous transhepatic-transjugular technique.
abstract: BACKGROUND
  The feasibility and efficacy of portacaval shunt creation through the transhepatic and transjugular approach were evaluated in patients with portal hypertension whose hepatic venous anatomies were unsuitable for the standard shunt procedure.
  
  
  METHODS
  Portacaval shunts were created via percutaneous transhepatic access in six patients. We used snares to target the portal vein and the inferior vena cava. Then a needle was introduced percutaneously and advanced through the snares. A guidewire was advanced through the needle and snared in the inferior vena cava. The wire was then withdrawn through the transjugular sheath. The rest of the procedure was completed in standard fashion. The transhepatic tracts were embolized.
  
  
  RESULTS
  The portacaval shunt procedures were successful in all patients. There were no major complications during the procedures, but one patient died of sepsis 1 week later. Two patients developed shunt occlusion, and in one case the shunt was revised successfully. The other patient with occlusion underwent orthotopic liver transplantation. The shunts in the remaining three patients and the revised shunt were patent at 5 to 20 months of follow-up.
  
  
  CONCLUSIONS
  Direct portacaval shunt creation using the percutaneous transhepatic and transjugular technique is a good alternative when standard portosystemic shunt creation is difficult or impossible.
authors.affiliation: Department of Radiology, Başkent University Faculty of Medicine, 06490, Ankara, Turkey.
authors.forename: C
authors.initials: C
authors.lastname: Aytekin
authors.forename: F
authors.initials: F
authors.lastname: Boyvat
authors.forename: A
authors.initials: A
authors.lastname: Firat
authors.forename: M
authors.initials: M
authors.lastname: Coşkun
authors.forename: S
authors.initials: S
authors.lastname: Boyacioğlu
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery*; D008297:Male; D011167:Portacaval Shunt, Surgical / Q000379:methods; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods; D014682:Vena Cava, Inferior