SONOGRAPHIC GUIDANCE FOR TRANSJUGULAR POR TAL-VEIN PUNCTURE

Successful completion of a transjugular intrahepatic portosystemic ste ntshunt (TIPSS) relies on knowledge of the individual hepatic vascular anatomy. The patients referred for TIPSS have an increased risk of co ntrast-medium-induced renal failure, and therefore the potential for a complete angiographic work-up during the procedure is limited. The sa me patient population also carries an increased risk of bleeding, whic h necessitates a rather accurate guiding technique for portal puncture s. We have established transcutaneous sonographic guidance as a standa rd technique for transjugular portal puncture, reducing complication r ates and intervention time. Competing imaging modalities for guidance are discussed.