Portal hypertension: Imaging of portosystemic collateral pathways and associated image-guided therapy

Figure 14 Transjugular intrahepatic portosystemic shunt procedure performed on a 54-year-old male with alcohol-induced cirrhosis and portal hypertension who presents with intractable ascites. A: Rosch-Uchida transjugular intrahepatic portosystemic shunt (TIPS) trochar-needle set (Cook Medical, Bloomington, United States) was advanced into an anterior branch of the right portal vein successfully after four attempts; B: Subsequently a wire and pigtail catheter were advanced into the main portal vein and subtraction angiography was performed demonstrating large dilated left gastric varices; C: Viatorr polytetrafluoroethylene (PTFE)-covered self-expanding stent (Gore Medical, Flagstaff, United States) was deployed over the tract; D: Completion portography demonstrates patency of the TIPS with decreased overall flow into the gastric varices.