Objective: Previously, splenoportography with 18-gauge needles provided excellent portal imaging. However, because of concern about bleeding, this technique was replaced with arterial portography and noninvasive techniques, which are not always accurate. We present a modification of splenoportography using CO2 and an ultrafine needle in eight patients whose previous imaging studies were inconclusive.
Conclusion: CO2 splenoportography is safe and expedient and provides adequate visualization of the portal system for surgical planning in selected patients.
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| http://dx.doi.org/10.2214/ajr.180.5.1801375 | DOI Listing |
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Advanced portal venous access techniques for transjugular intrahepatic portosystemic shunt placement.
BMJ Open Gastroenterol
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Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Introduction: Transjugular intrahepatic portosystemic shunt (TIPS) placement is a well-established but technically challenging procedure for the management of sequelae of end-stage liver disease. Performed essentially blindly, traditional fluoroscopically guided TIPS placement requires multiple needle passes and prolonged radiation exposure to achieve successful portal venous access, thus increasing procedure time and the risk of periprocedural complications. Several advanced image-guided portal access techniques, including intracardiac echocardiography (ICE)-guided access, cone-beam CT (CBCT)-guided access and wire-targeting access techniques, can serve as alternatives to traditional CO portography-based TIPS creation.
View Article and Find Full Text PDFUse of Virtual Target Fluoroscopic Display of Three-Dimensional CO Wedged Hepatic Vein Portography for TIPS Placement.
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Unité de Radiologie Interventionnelle, Hôpital Avicenne (APHP), Hôpitaux Universitaires Paris- Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, 125 Rue de Stalingrad 93000, Bobigny, France.
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Eur Radiol
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Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, People's Republic of China.
Objectives: The blind portal vein puncture remains the most challenging step during transjugular intrahepatic portosystemic shunt (TIPS) creation. We performed a prospective randomised clinical trial to compare three-dimensional (3D) roadmap with CO wedged hepatic vein portography for portal vein puncture guidance.
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Carbon dioxide-based portography: an alternative to conventional imaging with the use of iodinated contrast medium.
J Gastroenterol Hepatol
June 2010
Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, Chiba, Japan.
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False-positive "Cavernous Transformation" secondary to lymphatic filling in parenchymal hepatic CO(2) injection for portal vein visualization in TIPS procedures.
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May 2009
Department of Radiology, University of Florida College of Medicine, Gainesville, 32610-0374, USA.
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