CT-guided transfemoral portocaval shunt creation

A patient with superior vena cava (SVC) occlusion presented with severe asc ites and urgent transjugular intrahepatic portosystemic shunt (TIPS) was re quested. The patient had a chronically occluded SVC. An alternative to clas sic TIPS was employed using CT guidance to traverse the left portal vein to the inferior vena cava with a small gauge needle. Fluoroscopic guidance wa s then used to snare a wire placed through the needle and then work from th e femoral vein to create a portocaval shunt that passed through the caudate lobe. This procedure was a technical success and improved the patient's as cites.