Direct puncture of the recanalized paraumbilical vein for portal vein targeting during transjugular intrahepatic portosystemic shunt procedures: assessment of technical success and safety.
OBJECTIVE
To assess the success of direct percutaneous puncture of the recanalized paraumbilical vein (RPUV) for access and visualization of the portal vein (PV) to guide transhepatic puncture during transjugular intrahepatic portosystemic shunt (TIPS) creation. The predictive value of successful catheterization based on preprocedural vein diameter was analyzed.


METHODS
A retrospective review of all TIPS procedures from 2002 to 2008 performed at a single institution was conducted, and a subset of procedures in which portal venography was attempted via the paraumbilical vein were identified. In this subset, TIPS outcomes and diameters of the RPUV near the skin puncture site and left PV junction were measured and analyzed with a two-tailed Student t test.


RESULTS
During the study period, 114 TIPSs were created. RPUV punctures were found in 22 patients (19.3%) and portal venography was successful in 14 of the 22 patients (64%), all without complications. In the remainder (n = 8), access via the RPUV failed secondary to a small vein diameter (< 0.3 cm; n = 3), moderate to severe vessel tortuosity (n = 4), and distal thrombosis (n = 1). Puncture, catheterization, and portal venography was successful when the paraumbilical vein measured a mean of 0.75 cm at the skin and a mean of 0.84 cm at the junction with the left PV when analyzed against the failed attempts.


CONCLUSIONS
Portal venography via the RPUV is a feasible and probably safe alternative to other methods of PV opacification during TIPS procedures.
Chin
Matthew S
MS
Department of Radiology, University of North Carolina at Chapel Hill, CB 7510, 2nd Floor-Old Clinic Building, Chapel Hill, NC 27599-7510, USA.
Stavas
Joseph M
JM
Burke
Charles T
CT
Dixon
Robert G
RG
Mauro
Matthew A
MA
D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery*; D011170:Portasystemic Shunt, Surgical / Q000009:adverse effects / Q000379:methods*; D011677:Punctures / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D014471:Umbilical Veins / Q000601:surgery*