Transjugular intrahepatic portosystemic shunts and portal hypertension-related complications

Figure 1 Conventional transjugular intrahepatic portosystemic shunt insertion technique. A: From a transjugular approach, the right hepatic vein is catheterized; B: A needle inserted through the catheter is used to puncture the liver parenchyma and enters a portal vein branch; C: Transhepatic portogram with the tip of a calibrated catheter at the portosplenic confluence. This catheter is used to measure the length of the parenchymal tract for endograft placement; D: The parenchymal tract is then dilated with an angioplasty balloon to allow passage of the transjugular intrahepatic portosystemic shunt (TIPS) sheath into the portal vein; E: Once stent is fully deployed, an angioplasty balloon is used again to dilate the created tract to obtain the desirable portosystemic gradient (PSG); F: Trans-TIPS portal venography shows flow through the deployed stent. Peripheral portal vein branches are no longer opacified because of reversal of flow.