title: Retrospective analysis of venograms of hepatic and portal veins: clinical implications for transjugular intrahepatic portosystemic shunt placement.
abstract: OBJECTIVE
  This study was aimed to provide safety guidance of needle passes into the portal vein during transjugular intrahepatic portosystemic shunt (TIPS) placement.
  
  
  METHODS
  On anteroposterior venograms, the orifice of right hepatic trunk (RHT), furcation position, and branching of portal trunk in 128 patients underwent TIPS were mapped in relation to the vertebrae and intervertebral space. Impact of clinical factors on these parameters was determined.
  
  
  RESULTS
  The orifices of RHTs were all above the furcation position of portal trunk, RHTs were posterior and superior to portal branch. Of the 128 patients, 84.4% had the orifice positioned between 9th and 10th thoracic (T) vertebrae, 58.6% positioned to T10. Portal trunks were furcated between T11 and T12 in 80.5% patients. Portal trunks were bifurcated at right hepatic portal in 91.4% patients into left and right veins, and trifurcated into right posterior, right anterior and left branches in 8.6% patients. Statistical analysis indicated that these parameters were not affected by cause of disease, gender, age and Child-Pugh score.
  
  
  CONCLUSIONS
  The puncture site for portal vein located at or beyond imaged trunk furcation would be safe for most of the patients.
authors.forename: Jianping
authors.initials: J
authors.lastname: Qin
authors.forename: Shanhong
authors.initials: S
authors.lastname: Tang
authors.forename: Qianwen
authors.initials: Q
authors.lastname: He
authors.forename: Wen
authors.initials: W
authors.lastname: Tang
authors.forename: Xin
authors.initials: X
authors.lastname: Yao
authors.forename: Mingde
authors.initials: M
authors.lastname: Jiang
authors.forename: Jingping
authors.initials: J
authors.lastname: Sheng
authors.forename: Weizheng
authors.initials: W
authors.lastname: Zeng
authors.forename: Ming
authors.initials: M
authors.lastname: Gu
mesh_terms: D000328:Adult; D000368:Aged; D059925:Anatomic Landmarks; D006503:Hepatic Veins / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D006975:Hypertension, Portal / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D011169:Portal Vein / Q000000981:diagnostic imaging* / Q000601:surgery; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects; D011237:Predictive Value of Tests; D011677:Punctures; D012189:Retrospective Studies