chapter  18
14 Pages

CO2 Fine-Needle Transjugular Intrahepatic Portosystemic Shunt

WithIrvin F. Hawkins

Transjugular intrahepatic portosystemic shunt (TIPS) is one of the most demanding and

challenging procedures that interventional radiologists perform. The most difficult part

is localization of the portal vein. However, during the procedure, the hepatic capsular

may be penetrated, and the bile ducts and hepatic arteries are occasionally traversed,

resulting in a procedural mortality of as high as 4%. The fine-needle CO2 technique

described localizes the portal vein in 100% of patients and should reduce bleeding com-

plications by minimizing the trauma during the portal “search,” avoiding placing larger

catheters and stents across hepatic arteries, and should reduce fibrointimal hyperplasia

by avoiding impaling bile ducts.