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CVIR Endovascular
Fig. 2 | CVIR Endovascular

Fig. 2

From: Portal Vein Recanalization–Transjugular Intrahepatic Portosystemic Shunt (PVR-TIPS) with superior mesenteric vein access and balloon-assisted shunt placement

Fig. 2

DSA and fluoroscopic images of the Portal Vein Recanalization–Transjugular Intrahepatic Portosystemic Shunt (PVR-TIPS) with percutaneous ultrasound-guided superior mesenteric vein (SMV) access and balloon-assisted shunt placement. a Illustrates the pre-interventional findings: In the overview angiography via the sheath in the SMV, in the presence of known chronic occlusion, there is no contrast of the splenic vein. The portal vein (PV) can only be delineated in strands and is cavernously transformed (see also the magnified image in (b)). In addition, evidence of multiple portosystemic collaterals, especially extending paraesophageally (C). After probing of the right PV branch was successful, a balloon catheter was positioned in the main stem of the right PV to serve as target for TIPS needle puncture (c). Puncture of the balloon cover was eventually successful (d) and Archimedean (through and through) access was achieved (e). After deployment of the TIPS, a rapid contrast media outflow via the TIPS and a caliber reduction of the portosystemic collaterals is evident (f)

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