USE OF A HOOK CATHETER TO REVERSE UNFAVORABLE GUIDE-WIRE ORIENTATION DURING TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT PLACEMENT

TRANSJUGULAR intrahepatic portosystemic shunt (TIPS) placement is acce pted therapy for selected indications related to complications of port al hypertension (1.2). Although technically challenging; most TIPS pro cedures are completed within a few hours. The procedural time commonly depends an the ease or difficulty of puncture into a Portal vein bran ch hom the hepatic vein. Puncture into the portal venous system is occ asionally directed away from the main portal vein, and a guide wire pl aced through the needle may only pass to the liver periphery. For the TIPS to proceed to the nest step, the guide-wire orientation has to be reversed to access the central portal vein. Attempts to do this maybe unsuccessful, necesitating a further puncture, which increases the ri sk of hemorrhagic complications. We describe a method in which a sheph erds hook catheter is used to help reverse the direction of the guide wire when it is directed away from the main portal vein and ifs orient ation cannot be changed by means of manipulation.