The Usefulness of CO2 Indirect Portography in Transjugular Intrahepatic Portosystemic Shunt(TIPS)

ABSTRACT

PURPOSE: To determine the usefulness of carbon dioxide(CO2) indirect portography during TIPS procedure. MATERIALS AND METHODS: We evalvated eight patients who had undergone TIPS due to variceal hemorrhage or ascites caused by portal hypertension. All patients but one with complete situs inversus underwent wedged right hepatic venography for visualization of the portal vein using CO2. For CO2 indirect portal venography, 50cc of CO2 was injected by hand without prior injection of a small amount of CO2. In three patients a 5-F angiographic catheter was wedged into the right hepatic vein, and in the other five a 9-F sheath from a Ring 's transjugular access set was adjunctively wedged into the right hepatic vein over the 5-F catheter. The time required for portal vein puncture was defined as the time between the indirect portal venography procedure and the first procedure after successful portal vein puncture. RESULTS: All patients successfully underwent TIPS without any immediate complication. The portal vein was visualized by CO2 in 7 of 8 patients (87.5 %). Two of three patients who underwent indirect portography with only a 5-F catheter wedging demonstrated opacification of the right portal vein; in the remaining patient the portal venous system was not visualized. Of the five patients who underwent indirect portography with an adjunctive 9-F sheath wedged in the right hepatic vein, four showed opacification from the peripheral to the main portal vein, and in the other, the only right peripheral portal vein was opacified. The mean time for portal vein puncture was 20.5 minutes. CONCLUSION: For visualization of the portal venous system during TIPS procedure, the use of CO2 indirect portography is feasible.