A new coaxial needle system, hepatic artery targeting wire, and biplane fluoroscopy to increase safety and efficacy of TIPS.

To improve safety and efficacy of the transjugular intrahepatic portosystemic shunt (TIPS) procedure, we introduced a new, thin-needle (21-gauge long PTC needle) puncture technique using biplane fluoroscopy and targeting of a guidewire tip in the right hepatic artery. After puncture of the right portal vein, a 0.016-inch guidewire was inserted into the portal vein, followed by a 4 Fr dilator. The 4 Fr dilator allowed introduction of a 0.035-inch working guidewire. We successfully performed TIPS in seven patients with postnecrotic cirrhosis using this technique and encountered no technical difficulties or complications.