chapter  17
10 Pages

CO2 with Large-Needle TIPS

WithKyung J. Cho

Patients who require a transjugular intrahepatic portosystemic shunt (TIPS) placement

are usually at high risk of contrast nephrotoxicity because of impaired renal function

and dehydration. Therefore, CO2 should be used whenever possible, since it lacks

nephrotoxicity. CO2 can be used as a contrast agent for most parts of the procedure,

reserving the use of contrast medium for when CO2 cannot provide the necessary

information. During the procedure, CO2 is used for inferior vena cavography, hepatic

venography, wedged hepatic venography, splenoportography, and completion venogra-

phy. There is no limitation on the total volumes of CO2 that can be used in the portal

venous system. Manometry should be performed when CO2 injections result in incom-

plete filling of the portal venous system, during TIPS, or when a stenosis is suspected.