Fig. 1

Fluoroscopic images of the percutaneous puncture of the main trunk of the right portal vein and the IVC. A In this case, initially a small branch of the portal vein was punctured as is seen in fluoroscopy. This was not a suitable vessel for DIPS creation. B The tip of the needle is in the main trunk of the right portal vein (white arrow image B and D), this is confirmed by angiogram. C The needle is further advanced into the IVC and correct positioning is confirmed in angiography. D Note the in place “buddy-wire” entering the right trunk of the portal vein via the initial puncture site (white arrow, image B)