ABSTRACT
To mark the portal vein prior to transjugular intrahepatic portosystemic shunt (TIPS) placement, metallic coils adjacent to (n = 18) and a wire within (n = 18) the portal vein were placed with ultrasonographic (US) guidance. The mean number of punctures for successful portal vein entry was 3.0 with coils and 2.9 with a wire, and the mean total procedure time was 127.5 and 110.0 minutes, respectively (differences, not significant), and mean time at US was 20 and 10 minutes, respectively.
Subject(s)
Portal Vein/diagnostic imaging , Portasystemic Shunt, Surgical/methods , Ultrasonography, Interventional , Adult , Aged , Catheterization, Peripheral/instrumentation , Humans , Jugular Veins , Middle Aged , Portasystemic Shunt, Surgical/adverse effects , Portasystemic Shunt, Surgical/instrumentation , Portography , Prostheses and Implants , Punctures , Radiography, Interventional , Time FactorsABSTRACT
Central venous catheters inserted by blind surgical placement may not advance into a satisfactory position and may require repositioning. Malpositioning via surgical insertion is common in patients in whom central venous catheters have previously been placed, as these patients are more likely to have central venous thrombosis and distortion of central venous anatomy. This is less of a problem when catheter placement is guided by imaging; however, even when insertion is satisfactory, central venous catheters may become displaced spontaneously after insertion (Fig. 1). Repositioning can be effected by direct manipulation using guidewires or tip-deflecting wires [1, 2], by manipulation via a transfemoral venous approach [3-5], and by injection of contrast material or saline [6]. Limitations of the direct approach include (1) the number and type of maneuvers that can be performed to effect repositioning when anatomy is distorted, (2) difficulty in accessing the catheter, and (3) the risk of introducing infection. Moreover, these patients are often immunosuppressed, and there is a risk of introducing infection by exposing and directly manipulating the venous catheter. Vigorous injection of contrast material or saline may be unsuccessful for the same reasons: It seldom exerts sufficient force to reposition large-caliber central venous catheters and may cause vessel damage or rupture if injection is made into a small or thrombosed vessel. We illustrate several alternative methods for catheter repositioning via a transfemoral venous approach.
Subject(s)
Catheterization, Central Venous/methods , Radiography, Interventional , Adult , Catheterization, Central Venous/adverse effects , Catheterization, Peripheral , Female , Humans , Male , Middle Aged , Punctures , Radiography, ThoracicSubject(s)
Acquired Immunodeficiency Syndrome/complications , Myoglobinuria/complications , Nephritis/diagnostic imaging , Polymyositis/diagnostic imaging , Tomography, X-Ray Computed , Acute Disease , Adult , Humans , Kidney/diagnostic imaging , Male , Nephritis/complications , Polymyositis/complications , Psoas Muscles/diagnostic imaging , Rectus Abdominis/diagnostic imagingABSTRACT
In order to highlight the role of magnetic resonance angiography [MRA] in the assessment of patients pre-transjugular intrahepatic portosystemic shunt (TIPS) stenting, the MRA images of portal and hepatic veins of 21 patients were compared with the images from contrast portal and hepatic venograms performed on the same patients at the time of TIPS stenting (20 patients). MRA enabled accurate, non-invasive, multiplanar imaging of portal and systemic venous anatomy in each of the patients studied. MRA facilitated accurate determination of vessel patency and flow direction, images correlating exactly with contrast venograms of hepatic and portal veins in each case. In one patient, identification of occult hepatocellular carcinoma extending to the portal vein lead to the postponement of the TIPS procedure.
Subject(s)
Contrast Media , Hepatic Veins/diagnostic imaging , Hepatic Veins/pathology , Magnetic Resonance Angiography , Portal Vein/pathology , Portasystemic Shunt, Surgical/instrumentation , Portography , Stents , Adult , Aged , Aged, 80 and over , Female , Hemorrhage/surgery , Humans , Liver Cirrhosis, Alcoholic/surgery , Male , Middle Aged , Portasystemic Shunt, Surgical/methods , Radiology, Interventional , Varicose Veins/surgery , Vascular PatencyABSTRACT
Complications following venous punctures are unusual. We describe a case of a false common femoral vein aneurysm following right heart catheterization in a patient with systemic venous hypertension due to tricuspid regurgitation. The initial interpretation of the Doppler ultrasound study lead to a digital subtraction femoral arteriogram which was normal. Magnetic resonance venography demonstrated a femoral venous pseudoaneurysm.
