Hepatic laceration from wedged venography performed before transjugular intrahepatic portosystemic shunt placement

摘要: Transjugular intrahepatic portosystemic shunt (TIPS) placement is an increasingly used, nonoperative technique for treating variceal bleeding and refractory ascites secondary to portal hypertension. Since the first clinical TIPS case in 1989, procedure has undergone significant technical refinement improve safety efficacy of placement. A major challenge creation passage transjugular needle from hepatic vein into vein. Perforation liver capsule errant pass can lead massive intraperitoneal bleeding. To minimize number passes required enter vein, investigators have devised a variety techniques visualize anatomy including direct transhepatic catheterization superior mesenteric artery (SMA) angiography, real-time ultrasound (US) guidance refluxing contrast medium with wedged venography. While these improvements made safe attractive alternative conventional surgical shunts, remains technically challenging lethal hemorrhagic complications occur when perforated during course procedure. our knowledge, there are no reported directly related venogram prior TIPS. We describe unusual series severe injuries venography attempts localize