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The Gun-Site and Percutaneous Portocaval Techniques for the Challenging TIPS 

The Gun-Site and Percutaneous Portocaval Techniques for the Challenging TIPS
Chapter:
The Gun-Site and Percutaneous Portocaval Techniques for the Challenging TIPS
Author(s):

S. Lowell Kahn

DOI:
10.1093/med/9780199986071.003.0077
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date: 26 February 2021

Since its inception, the “Achilles’ heel” of the transjugular intrahepatic portosystemic shunt (TIPS) procedure has been catheterization of the portal vein from the systemic venous circulation. In the majority of TIPS procedures, the portal vein is readily identified with conventional technique and the procedure is completed in no more than 60–90 minutes, if not less. However, there are certain anatomic situations that can make performance of a TIPS procedure difficult. A small cirrhotic liver with an abnormal hepatic to portal venous orientation, t hrombosis or cavernous transformation of the portal vasculature, and atrophic or absent (Budd–Chiari) hepatic veins all produce unique challenges for the interventionalist. In such situations, the use of alternative TIPS techniques may be warranted. In this chapter, two alternative TIPS techniques are discussed to assist with challenging anatomy.

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