title: Direct intrahepatic cavo-portal shunts in Budd-Chiari syndrome: Role of simultaneous fluoroscopy and trans-abdominal ultrasonography.
abstract: BACKGROUND
  Transjugular intrahepatic porto-systemic shunt (TIPS) for Budd-Chiari syndrome (BCS) can be inserted from inferior vena cava or hepatic vein to portal vein. The former is performed when hepatic veins are not suitable and is technically more challenging.
  
  
  METHODS
  In this retrospective study, 7 patients with chronic BCS needed cavo-portal shunt as hepatic veins were neither amenable to plasty nor provided access for TIPS placement. Simultaneous fluoroscopic and trans-abdominal ultrasound guidance was used at the time of portal vein puncture.
  
  
  RESULTS
  Technical success and clinical improvement were obtained in all patients. Median 3 (range 1-4) attempts were needed to puncture the portal vein. There were no significant complications. Uncovered stents were used in six patients and stent occlusion was common, but could be managed by re-intervention.
  
  
  CONCLUSIONS
  Cavo-portal shunt is an effective technique for patients with BCS uncontrolled by medical therapy. Additional trans-abdominal ultrasound in oblique parasagittal plane keeps the procedure safe.
authors.affiliation: Department of Radiology, Christian Medical College and Hospital, Vellore 632 004, India. aparna_shyam@yahoo.com
authors.forename: Shyamkumar N
authors.initials: SN
authors.lastname: Keshava
authors.forename: Gopi Krishna
authors.initials: GK
authors.lastname: Kota
authors.forename: Thomas
authors.initials: T
authors.lastname: Mammen
authors.forename: R
authors.initials: R
authors.lastname: Jeyamani
authors.forename: Vinu
authors.initials: V
authors.lastname: Moses
authors.forename: Shalini
authors.initials: S
authors.lastname: Govil
authors.forename: George
authors.initials: G
authors.lastname: Kurian
authors.forename: George
authors.initials: G
authors.lastname: Chandy
mesh_terms: D000328:Adult; D006502:Budd-Chiari Syndrome / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery*; D002648:Child; D005260:Female; D005471:Fluoroscopy; D006503:Hepatic Veins / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography