A NEW COAXIAL NEEDLE SYSTEM, HEPATIC-ARTERY TARGETING WIRE, AND BIPLANE FLUOROSCOPY TO INCREASE SAFETY AND EFFICACY OF TIPS

To improve safety and efficacy of the transjugular intrahepatic portos ystemic shunt (TIPS) procedure, we introduced a new, thin-needle (21-g auge long PTC needle) puncture technique using biplane fluoroscopy and targeting of a guidewire tip in the right hepatic artery. After punct ure of the right portal vein, a 0.016-inch guidewire was inserted into the portal vein, followed by a 4 Fr dilator. The 4 Fr dilator allowed introduction of a 0.035-inch working guidewire. We successfully perfo rmed TIPS in seven patients with postnecrotic cirrhosis using this tec hnique and encountered no technical difficulties or complications.