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Ultrasound-guided transhepatic puncture of the hepatic veins for TIPS placement

Puntura transepatica ecoguidata delle vene sovraepatiche per il confezionamento della TIPS

  • Vascular and Interventional Radiology / Radiologia Vascolare e Interventistica
  • Published:
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Abstract

Purpose

This retrospective analysis was carried out to assess the feasibility and results of transjugular intrahepatic portal systemic shunt (TIPS) performed with ultrasound (US)-guided percutaneous puncture of the hepatic veins.

Material and methods

Over a period of 3 years, 153 patients were treated with TIPS at our centre. In eight cases, a percutaneous puncture of the middle (n=7) or right (n=1) hepatic vein was required because the hepatic vein ostium was not accessible. Indications for TIPS were bleeding (n=1), Budd-Chiari syndrome (n=1), ascites (n=2), reduced portal flow (n=1) and incomplete portal thrombosis (n=3). A 0.018-in. guidewire was anterogradely introduced into the hepatic vein to the inferior vena cava (IVC) through a 21-gauge needle. In the meantime, a 25-mm snare-loop catheter was introduced through the jugular access to retrieve the guidewire, achieving through-andthrough access. Then, a Rosch-Uchida set was used to place the TIPS with the traditional technique.

Results

Technical success was achieved in all patients. There was one case of stent thrombosis. One patient died of pulmonary oedema. Three patients were eligible for liver transplantation, whereas the others were excluded due to shunt thrombosis (n=1) and previous nonhepatic neoplasms (n=3).

Conclusions

The percutaneous approach to hepatic veins is rapid and safe and may be useful for avoiding traumatic liver injuries.

Riassunto

Obiettivo

Scopo del presente lavoro è stato analizzare retrospettivamente fattibilità e risultati della transjugular intrahepatic portal systemic shunt (TIPS) confezionata con puntura percutanea eco-guidata delle vene epatiche.

Materiali e metodi

Nell’arco di 3 anni, 153 pazienti sono stati sottoposti a TIPS. In 8 casi si è resa necessaria la puntura percutanea delle vene epatiche mediana (n=7) o destra (n=1), dopo tentativi fallimentari di cateterismo retrogrado ostiale. Le indicazioni alla TIPS erano: 1 sanguinamento, 1 sindrome di Budd-Chiari, 2 asciti, 1 ipoafflusso portale e 3 trombosi portali incomplete. Attraverso un ago di 21G per via anterograda è stata introdotta dalla vena epatica in vena cava inferiore (VCI) una guida di 0,018 pollici. Contemporaneamente dall’accesso giugulare la guida è stata catturata ed esteriorizzata con un catetere a laccio di 25 mm, per veicolare su di essa il set di Rösch-Uchida e confezionare la TIPS con tecnica classica.

Risultati

Il successo tecnico è stato ottenuto in tutti i pazienti. Abbiamo registrato 1 trombosi dello stent. Un paziente è deceduto per edema polmonare; 3 pazienti sono eleggibili per il trapianto epatico, mentre gli altri sono stati esclusi per occlusione dello shunt (n=1) o pregresse neoplasie extraepatiche (n=3).

Conclusioni

L’approccio percutaneo alle vene epatiche è rapido, sicuro ed utile nell’evitare lesioni epatiche traumatiche.

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Authors and Affiliations

  1. Istituto di Radiologia, Università degli Studi di Torino, Ospedale S. Giovanni Battista di Torino, Via Genova 3, 10126, Torino, Italy

    C. Gazzera, P. Fonio, C. Gallesio, F. Camerano, A. Doriguzzi Breatta, D. Righi & G. Gandini

  2. Istituto di Radiologia, 2a Facoltà, Università degli Studi di Torino, Ospedale San Luigi Gonzaga, Orbassano (TO), Italy

    A. Veltri

Authors
  1. C. Gazzera
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  2. P. Fonio
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  3. C. Gallesio
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  4. F. Camerano
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  5. A. Doriguzzi Breatta
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  6. D. Righi
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  7. A. Veltri
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  8. G. Gandini
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Correspondence to C. Gallesio.

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Gazzera, C., Fonio, P., Gallesio, C. et al. Ultrasound-guided transhepatic puncture of the hepatic veins for TIPS placement. Radiol med 118, 379–385 (2013). https://doi.org/10.1007/s11547-012-0853-3

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  • DOI: https://doi.org/10.1007/s11547-012-0853-3

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