A Method to Prevent Life-threatening Intraperitoneal Bleeding During Transjugular Intrahepatic PortosystemicShunt Creation

Ryeom, Hun Kyu; Kim, Yong Joo

Abstract

PURPOSE: To prevent intraperitoneal bleeding, it is critical that the extrahepatic portal vein should not bepunctured during transjugular intrahepatic portosystemic shunt (TIPS). There has, however, been no procedure fordefining the anatomic relationship between the hepatic capsule and the portal vein segment before shunt formation.To avoid a possibly catastrophic outcome of extrahepatic portal puncture before shunt creation, we thereforedevised a new method; the purpose of this study is to report its efficacy and feasibility.
MATERIALS AND METHODS
Whenever a portal vein was punctured, we advanced a 9F sheath over a guidewire into the portal vein before balloondilatation of the tract. Contrast material was then injected through the sheath as this was slowly withdrawn fromthe portal vein towards the hepatic vein. When contrast material extravasated or spilled into the peritonealspace, thus suggesting extrahepatic portal vein puncture, a more peripheral segment of the portal vein waspunctured, and a shunt was created using this new tract. We applied this method to 130 consecutive patients whounderwent TIPS to control variceal bleeding due to liver cirrhosis. In all cases, portography and ultrasonographywere used for immediate confirmation of the procedure.
RESULTS
Puncture of the extrahepatic portal vein segmentoccurred in three out 130 (2.3%) patients. In these three, TIPS was successfully created using the methoddescribed above. Clinical and ultrasonographic follow-up showed that no patients suffered intraperitonealbleeding.
CONCLUSION
For preventing intraperitoneal hemorrhage during TIPS creation, our method is effective andfeasible.