Novel Image Guidance Techniques for Portal Vein Targeting During Transjugular Intrahepatic Portosystemic Shunt Creation

• Published in: Techniques in vascular and interventional radiology Vol. 19; no. 1; pp. 10 - 20
• Main Authors: Farsad, Khashayar, Kaufman, John A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2016
• Subjects: Computed Tomography Angiography; Fluoroscopy; Hematology, Oncology and Palliative Medicine; Hepatic Veins - diagnostic imaging; Hepatic Veins - surgery; Humans; image guidance; Intravascular ultrasound; Magnetic Resonance Angiography; Magnetic Resonance Imaging, Interventional; Phlebography; portal vein; Portal Vein - diagnostic imaging; Portal Vein - surgery; Portasystemic Shunt, Transjugular Intrahepatic - adverse effects; Portasystemic Shunt, Transjugular Intrahepatic - methods; Portography; Radiography, Interventional; Radiology; transjugular intrahepatic portosystemic shunt; Treatment Outcome; Ultrasonography, Interventional; portal vein; portography; Intravascular ultrasound; transjugular intrahepatic portosystemic shunt; image guidance
• ISSN: 1089-2516; 1557-9808
• DOI: 10.1053/j.tvir.2016.01.002

The most challenging part of transjugular intrahepatic portosystemic shunt creation is arguably the transvenous access from the hepatic vein to the portal vein. As experience and technology have evolved, the image guidance aspect of this critical step in the procedure has become more robust. Improved means to target the portal vein include both direct and indirect methods of portal vein opacification, cross-sectional imaging for both targeting and access, and novel use of transabdominal and intravascular ultrasound guidance. These techniques are described herein.