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Transmesenteric Method of TIPS Placement Using Portal Access via Mini-Laparotomy 

Transmesenteric Method of TIPS Placement Using Portal Access via Mini-Laparotomy
Chapter:
Transmesenteric Method of TIPS Placement Using Portal Access via Mini-Laparotomy
Author(s):

Sam McCabe

, Christopher Harnain

, and Grigory Rozenblit

DOI:
10.1093/med/9780199986071.003.0079
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date: 18 February 2020

Transmesenteric portal access via mini-laparotomy may be used as a salvage technique when standard transjugular intrahepatic portosystemic shunt (TIPS) is unsuccessful due to difficult anatomy or portal vein thrombosis. This technique allows for precise determination of both the portal and the hepatic vein branch involved in the TIPS. This method usually involves the cooperation of a surgeon, who performs a mini-laparotomy and exposes a small bowel loop in the interventional suite. A mesenteric venous branch is then cannulated, providing direct access to the portal venous system. In distinction to standard technique, the hepatic parenchymal tract is created by a puncture from the portal vein into the hepatic vein. A guidewire advanced through the puncture needle is then snared from the hepatic vein, providing through-and-through access. The TIPS can be completed using standard techniques. Upon completion, the mini-laparotomy is closed by the surgeon.

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