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Optimal Imaging Techniques of the Portal Vasculature During TIPS Creation: Use of the CO2 Portogram 

Optimal Imaging Techniques of the Portal Vasculature During TIPS Creation: Use of the CO2 Portogram
Chapter:
Optimal Imaging Techniques of the Portal Vasculature During TIPS Creation: Use of the CO2 Portogram
Author(s):

Hector Ferral

DOI:
10.1093/med/9780199986071.003.0074
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date: 23 September 2021

Transjugular intrahepatic portosystemic shunt creation is one of the most complex interventional procedures. It requires skills in imaging, vessel catheterization, guidewire techniques, balloon angioplasty, endovascular stent deployment, and embolization techniques. The key step during this procedure is obtaining access into the portal vein. This chapter discusses how to perform a CO2 portogram to obtain access to the portal vein during the creation of a transjugular intrahepatic portosystemic shunt (TIPS). The CO2 portogram may be performed with an angiographic catheter wedged in the hepatic vein, with an occlusion balloon inflated within the hepatic vein, or with the transhepatic needle within the liver parenchyma—the so-called “intraparenchymal” injection. Those performing a CO2 portogram should have knowledge of CO2 and a user-friendly CO2 delivery system to avoid common CO2 complications.

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