Ultrasonography-guided percutaneous transhepatic portacaval shunt creation.
We successfully created a percutaneous transhepatic portacaval shunt under ultrasonography (US) guidance in a 46-year-old man with refractory ascites. The shunt was created to salvage an attempt to create a transjugular intrahepatic portosystemic shunt (TIPS) that failed because of the elevated level of portal vein bifurcation due to alcoholic liver cirrhosis. Under US guidance, we simultaneously punctured the right branch of the portal vein and the inferior vena cava (IVC) using a two-step biliary drainage set. An Amplatz gooseneck snare was introduced transjugularly to retrieve the percutaneously inserted guidewire. The intrahepatic tract between the portal vein and the IVC was dilated using a balloon catheter, and a stent was placed in the tract. The patient showed complete resolution of ascites at discharge. We assume that our method is an alternative method for TIPS creation in patients with inadequate anatomical relations between the portal vein branches and the hepatic veins. This approach is thought to be feasible for patients with occluded or small hepatic veins.
Honda
Minoru
M
Department of Radiology, Showa University Hospital, Tokyo, Japan. hondamin@med.showa-u.ac.jp
Baba
Toshiyuki
T
Hashimoto
Toshi
T
Seino
Noritaka
N
Gokan
Takehiko
T
D001201:Ascites / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications; D008297:Male; D008875:Middle Aged; D011167:Portacaval Shunt, Surgical / Q000379:methods*; D016879:Salvage Therapy; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional
Abdom Imaging. 2003 Mar-Apr;28(2):287-92
12592481
J Vasc Interv Radiol. 1996 Jan-Feb;7(1):139-42
8773989
J Vasc Interv Radiol. 1999 Oct;10(9):1233-8
10527201
Radiology. 2008 Jan;246(1):306-14
18096542
AJR Am J Roentgenol. 2006 Jul;187(1):W87-91
16794144
J Vasc Interv Radiol. 2003 Jan;14(1):21-32
12525583
Radiology. 1990 Mar;174(3 Pt 2):1027-30
2305084
Cardiovasc Intervent Radiol. 2006 Sep-Oct;29(5):857-61
16810460
Cardiovasc Intervent Radiol. 2006 Jul-Aug;29(4):565-70
16729230