title: Transcaval transjugular intrahepatic portosystemic shunt: preliminary clinical results.
abstract: OBJECTIVE
  To determine the feasibility of transcaval transjugular intrahepatic portosystemic shunt (TIPS) creation in patients with unusual anatomy between the hepatic veins and portal bifurcation, and inaccessible or inadequate hepatic veins.
  
  
  METHODS
  Transcaval TIPS, performed in six patients, was indicated by active variceal bleeding (n=2), recurrent variceal bleeding (n=2), intractable ascites (n=1), and as a bridge to liver transplantation (n=1). The main reasons for transcaval rather than classic TIPS were the presence of an unusually acute angle between the hepatic veins and the level of the portal bifurcation (n=3), hepatic venous occlusion (n=2), and inadequate small hepatic veins (n=1).
  
  
  RESULTS
  Technical and functional success was achieved in all patients. The entry site into liver parenchyma from the inferior vena cava was within 2 cm of the atriocaval junction. Procedure-related complications included the death of one patient due to hemoperitoneum despite the absence of contrast media spillage at tractography, and another suffered reversible hepatic encephalopathy.
  
  
  CONCLUSIONS
  In patients with unusual anatomy between the hepatic veins and portal bifurcation, and inaccessible or inadequate hepatic veins, transcaval TIPS creation is feasible.
authors.affiliation: Department of Diagnostic Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Kwang-Hun
authors.initials: KH
authors.lastname: Lee
authors.forename: Do-Yun
authors.initials: DY
authors.lastname: Lee
authors.forename: Jong-Yoon
authors.initials: JY
authors.lastname: Won
authors.forename: Sang Joon
authors.initials: SJ
authors.lastname: Park
authors.forename: Jae Kyu
authors.initials: JK
authors.lastname: Kim
authors.forename: Woong
authors.initials: W
authors.lastname: Yoon
mesh_terms: D000328:Adult; D000368:Aged; D006502:Budd-Chiari Syndrome / Q000150:complications; D004932:Esophageal and Gastric Varices / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000601:surgery*; D006503:Hepatic Veins / Q000033:anatomy & histology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000033:anatomy & histology; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods*; D014682:Vena Cava, Inferior