Authors: Minoru Honda Toshiyuki Baba Toshi Hashimoto Noritaka Seino Takehiko Gokan
Publish Date: 2010/08/27
Volume: 28, Issue: 7, Pages: 542-546
Abstract
We successfully created a percutaneous transhepatic portacaval shunt under ultrasonography US guidance in a 46yearold man with refractory ascites The shunt was created to salvage an attempt to create a transjugular intrahepatic portosystemic shunt TIPS that failed because of the elevated level of portal vein bifurcation due to alcoholic liver cirrhosis Under US guidance we simultaneously punctured the right branch of the portal vein and the inferior vena cava IVC using a twostep biliary drainage set An Amplatz gooseneck snare was introduced transjugularly to retrieve the percutaneously inserted guidewire The intrahepatic tract between the portal vein and the IVC was dilated using a balloon catheter and a stent was placed in the tract The patient showed complete resolution of ascites at discharge We assume that our method is an alternative method for TIPS creation in patients with inadequate anatomical relations between the portal vein branches and the hepatic veins This approach is thought to be feasible for patients with occluded or small hepatic veins
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