The anatomic study of imageology related to TIPS

Purpose: To further increase the success rate, safety and reliability of TIPS procedures and search for new ways for portosystemic shunts and puncture guidance. Materials and methods: Using various medical imaging and anatomical methods, the detail relationships of hepatic arteries (HA) and bile ducts (BD) to portal veins (PV) were studied and the possibilities of injury to them in different puncture routes were estimated. The anatomic relationships between the hepatic segment of inferior vena cava (HIVC) and PV and the possibility of portal-vena cava shunt were also investigated. Results: The BD and HA were mainly located anterior or anterior-superior to the PV branch or mainstams of right PV and left PV, but the corner-and sagittal parts of left PV and bifurcation of right PV were often surrounded by them. HA, especially the right HA, going parallel to the mainstam of right PV in a regular ways, could be used for PV puncture guidance. HIVC came close to the PV in the region of hepatic porta, puncture from inferior vena cava (IVC) to PV possessing a wide range of safety, could be used as a new route for portal-cava shunt in order to avoid the hepatic vein. Conclusion: Familiarization with liver anatomy and reliable guidance during TIPS procedure was crucial to avoid serious complications of damage to BD and HA. Creating shunt with stent-grafts from the HIVC to PV directly is a promising way to prevent restenosis