title: Balloon occlusion versus wedged hepatic venography using iodinated contrast for targeting the portal vein during TIPS.
abstract: OBJECTIVE
  To assess the efficacy, safety and gain in procedure time of the technique of balloon occlusion hepatic venography with iodinated contrast used to target the portal vein during TIPS. The technique is assessed versus wedged hepatic venography.
  
  
  METHODS
  Fifty-eight TIPS were prospectively included. The portal vein was located in 30 cases by the wedged hepatic venography (group 1) and in 28 cases by balloon occlusion hepatic venography (group 2). To compare both techniques a "portogram quality" score was defined using a 5 points scale. The time required to achieve portal puncture was also recorded. The complications of both procedures were assessed and classified in groups as intrahepatic hematoma or intraperitoneal hemorrhage.
  
  
  RESULTS
  The right portal vein was visualized in a significantly higher number of patients using balloon than with wedged retrograde venography 71.3% (20/28) versus 13.3% (4/30) respectively (P=0.002). The quality score for the portogram was significantly higher for balloon hepatic venography 2.21 than for wedged hepatic venography 1.07 (P=0.002). The mean time required to puncture the portal vein was significantly shorter when the right branch of the portal vein was visualized 21 min versus 33.5 min (P=0.046). We recorded one intrahepatic hematoma (3.3%) and 4 intraperitoneal hemorrhage (13.3%) secondary to wedged hepatic venography. There were no complications with balloon occlusion hepatic venography (P=0.053).
  
  
  CONCLUSIONS
  The use of balloon occlusion hepatic venography improves the quality of the retrograde portal venography to target the portal vein and decreases procedure time. The balloon technique is also burdened with fewer complications than the standard wedged hepatic venography.
authors.affiliation: Hospital « la Timone », Public assistance-Marseille's hospitals, 264, avenue Saint-Pierre, 13385 cedex Marseille, France. Electronic address: jmcaporossi@hotmail.fr.
authors.forename: J-M
authors.initials: JM
authors.lastname: Caporossi
authors.affiliation: Hospital « la Timone », Public assistance-Marseille's hospitals, 264, avenue Saint-Pierre, 13385 cedex Marseille, France.
authors.forename: V
authors.initials: V
authors.lastname: Vidal
authors.affiliation: Hospital « la Timone », Public assistance-Marseille's hospitals, 264, avenue Saint-Pierre, 13385 cedex Marseille, France.
authors.forename: A
authors.initials: A
authors.lastname: Jacquier
authors.affiliation: Hospital « la Timone », Public assistance-Marseille's hospitals, 264, avenue Saint-Pierre, 13385 cedex Marseille, France.
authors.forename: A
authors.initials: A
authors.lastname: Reyre
authors.affiliation: Hospital « la Timone », Public assistance-Marseille's hospitals, 264, avenue Saint-Pierre, 13385 cedex Marseille, France.
authors.forename: A
authors.initials: A
authors.lastname: Flavian
authors.affiliation: Hospital « la Timone », Public assistance-Marseille's hospitals, 264, avenue Saint-Pierre, 13385 cedex Marseille, France.
authors.forename: C
authors.initials: C
authors.lastname: Muller
authors.affiliation: Hospital « la Timone », Public assistance-Marseille's hospitals, 264, avenue Saint-Pierre, 13385 cedex Marseille, France.
authors.forename: J-Y
authors.initials: JY
authors.lastname: Gaubert
authors.affiliation: Hospital « la Timone », Public assistance-Marseille's hospitals, 264, avenue Saint-Pierre, 13385 cedex Marseille, France.
authors.forename: J-M
authors.initials: JM
authors.lastname: Bartoli
authors.affiliation: Hospital « la Timone », Public assistance-Marseille's hospitals, 264, avenue Saint-Pierre, 13385 cedex Marseille, France.
authors.forename: G
authors.initials: G
authors.lastname: Moulin
authors.affiliation: Hospital « la Timone », Public assistance-Marseille's hospitals, 264, avenue Saint-Pierre, 13385 cedex Marseille, France.
authors.forename: A
authors.initials: A
authors.lastname: Varoquaux
mesh_terms: D021721:Balloon Occlusion; D003287:Contrast Media; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D011169:Portal Vein / Q000000981:diagnostic imaging; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods*; D011446:Prospective Studies; D014283:Triiodobenzoic Acids
chemical_list: D003287:Contrast Media; D014283:Triiodobenzoic Acids; C044834:iodixanol
keywords: Balloon occlusion; Portal hypertension; TIPS