title: Ultrasound-guided transhepatic puncture of the hepatic veins for TIPS placement.
abstract: OBJECTIVE
  This retrospective analysis was carried out to assess the feasibility and results of transjugular intrahepatic portal systemic shunt (TIPS) performed with ultrasound (US)-guided percutaneous puncture of the hepatic veins.
  
  
  METHODS
  Over a period of 3 years, 153 patients were treated with TIPS at our centre. In eight cases, a percutaneous puncture of the middle (n=7) or right (n=1) hepatic vein was required because the hepatic vein ostium was not accessible. Indications for TIPS were bleeding (n=1), Budd-Chiari syndrome (n=1), ascites (n=2), reduced portal flow (n=1) and incomplete portal thrombosis (n=3). A 0.018-in. guidewire was anterogradely introduced into the hepatic vein to the inferior vena cava (IVC) through a 21-gauge needle. In the meantime, a 25-mm snare-loop catheter was introduced through the jugular access to retrieve the guidewire, achieving through-andthrough access. Then, a Rosch-Uchida set was used to place the TIPS with the traditional technique.
  
  
  RESULTS
  Technical success was achieved in all patients. There was one case of stent thrombosis. One patient died of pulmonary oedema. Three patients were eligible for liver transplantation, whereas the others were excluded due to shunt thrombosis (n=1) and previous nonhepatic neoplasms (n=3).
  
  
  CONCLUSIONS
  The percutaneous approach to hepatic veins is rapid and safe and may be useful for avoiding traumatic liver injuries.
authors: Istituto di Radiologia, Università degli Studi di Torino, Ospedale S. Giovanni Battista di Torino, Torino, Italy. carlogazzera@inwind.it
authors: C
authors: C
authors: Gazzera
authors: P
authors: P
authors: Fonio
authors: C
authors: C
authors: Gallesio
authors: F
authors: F
authors: Camerano
authors: A
authors: A
authors: Doriguzzi Breatta
authors: D
authors: D
authors: Righi
authors: A
authors: A
authors: Veltri
authors: G
authors: G
authors: Gandini
mesh_terms: D000328:Adult; D000368:Aged; D003287:Contrast Media; D005240:Feasibility Studies; D005260:Female; D006503:Hepatic Veins / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology* / Q000601:surgery*; D007472:Iohexol / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods*; D011183:Postoperative Complications; D011677:Punctures; D012189:Retrospective Studies; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D003287:Contrast Media; D007472:Iohexol; C038192:iopromide