title: Transhepatic puncture of portal and hepatic veins for TIPS using a single-needle pass under sonographic guidance.
abstract: OBJECTIVE
  Creating transjugular intrahepatic portosystemic shunts (TIPS) requires accessing a portal vein branch from a metal cannula wedged in a hepatic vein. This initial step in shunt creation often requires multiple blind intrahepatic punctures and occasionally fails. We describe a method using sonographic guidance to serially puncture the portal vein and hepatic vein with a single transhepatic needle pass, after which the TIPS procedure is completed in the standard transjugular fashion.
  
  
  CONCLUSIONS
  Sonographically guided transhepatic dual puncture of the portal and hepatic veins facilitates portosystemic shunt creation in a single needle pass and allows more controlled selection of the portal vein entry and hepatic vein landing sites in selected patients.
authors.affiliation: Department of Radiology, Memorial Herman Hospital, 902 Frostwood, Ste. 275, Houston, TX 77024, USA. asadraza@sbcglobal.net
authors.forename: Syed A
authors.initials: SA
authors.lastname: Raza
authors.forename: Eric
authors.initials: E
authors.lastname: Walser
authors.forename: Alberto
authors.initials: A
authors.lastname: Hernandez
authors.forename: Keven
authors.initials: K
authors.lastname: Chen
authors.forename: Santiago
authors.initials: S
authors.lastname: Marroquin
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006503:Hepatic Veins / Q000000981:diagnostic imaging*; D006801:Humans; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging*; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods*; D011677:Punctures / Q000379:methods; D018084:Ultrasonography, Interventional