ABSTRACT
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.
