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Percutaneous Sonographic Guidance for TIPS in Budd-Chiari Syndrome: Direct Simultaneous Puncture of the Portal Vein and Inferior Vena Cava

Fatih Boyvat1, Ali Harman1, Umut Ozyer1, Cuneyt Aytekin1 and Zubeyde Arat2

1 Radiology Department, Baskent University, Fevzi Cakmak Cad. 10. Sok. No. 45 06490, Ankara, Turkey.
2 Nephrology Department, Baskent University, Ankara, Turkey.


Figure 1
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  		Fig. 1A —43-year-old woman with Budd-Chiari syndrome in Child-Pugh class B and intractable ascites. Subcostal sonographic image shows left portal vein (thin arrow) and inferior vena cava (thick arrow) in same plane.

 

Figure 2
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  		Fig. 1B —43-year-old woman with Budd-Chiari syndrome in Child-Pugh class B and intractable ascites. Radiograph shows track dilated with 8-mm balloon catheter.

 

Figure 3
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  		Fig. 1C —43-year-old woman with Budd-Chiari syndrome in Child-Pugh class B and intractable ascites. Portogram shows good flow through shunt after stent placement.

 

Figure 4
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  		Fig. 2A —6-year-old girl who underwent percutaneous shunt placement because of variceal bleeding and ascites. Sonographic image shows needle tip was in left portal vein (black arrow). Balloon catheter was placed in inferior vena cava to facilitate percutaneous puncture (white arrows).

 

Figure 5
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  		Fig. 2B —6-year-old girl who underwent percutaneous shunt placement because of variceal bleeding and ascites. Radiograph shows balloon punctured and glidewire advanced.

 

Figure 6
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  		Fig. 2C —6-year-old girl who underwent percutaneous shunt placement because of variceal bleeding and ascites. Portal venogram after transjugular portosystemic shunt placement shows excellent shunt.

 

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