Reducing risk of transjugular intrahepatic portosystemic shunt using ultrasound guided single needle pass

Abstract

Delayed liver laceration following transjugular intrahepatic portosystemic shunt (TIPS) is a serious and likely underdiagnosed complication. It is however an important complication following TIPS, which remains one of the most technically challenging interventional procedures performed. In addition to laceration, a number of complications regarding bleeding and perforation are well described following TIPS procedures. We feel the adoption of techniques such as ours and that of other authors described in the literature using an ultrasound-guided percutaneous transhepatic approach with a small caliber needle provides a safer and less traumatic procedure and should reduce complications of bleeding and almost completely eliminate the risk of liver laceration. Our procedure was successfully performed under conscious sedation rather than general anaesthesia further reducing the overall procedural risk to the patient.

Keywords: Transjugular portal systemic shunt, Ultrasound guided, Haemorrhage, Complication, Reducing, Morbidity, Death, Liver, Laceration

Core tip: Transjugular intrahepatic portosystemic shunt (TIPS) for complications of portal hypertension is commonly formed by accessing a portal vein branch from a metal cannula wedged in a hepatic vein. A number of serious procedural complications including bleeding and perforation following TIPS have been described. We feel the adoption of techniques such as ours and that of other authors described in the literature using an ultrasound-guided percutaneous transhepatic approach with a small caliber needle provides a safer and less traumatic procedure and should reduce complications of bleeding and almost completely eliminate the risk of liver laceration.