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Use of Prolapsing Guidewire to Secure Portal Venous Access During the TIPS Procedure 

Use of Prolapsing Guidewire to Secure Portal Venous Access During the TIPS Procedure
Chapter:
Use of Prolapsing Guidewire to Secure Portal Venous Access During the TIPS Procedure
Author(s):

Thomas Kinney

, and Kazim Narsinh

DOI:
10.1093/med/9780199986071.003.0075
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date: 29 January 2020

Perhaps the most critical portion of the transjugular intrahepatic portosystemic shunt procedure involves obtaining secure portal venous access. An acute angle of entry into the portal venous system during intrahepatic portosystemic shunt creation can make retrograde advancement of a guidewire into the splenic or superior mesenteric vein difficult. However, securing access from the jugular access site to the portal system with a reliable guidewire is of critical importance during the procedure. This chapter presents a technique to advance a flexible-tip guidewire antegrade into right portal vein branches prior to prolapsing the guidewire into the main portal vein to secure transjugular portal venous access.

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