TIPS procedure sample dictation

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Radiologist: []


Procedure: TIPS procedure.


Clinical history: []


Technique: Informed consent was obtained. The patient was identified and placed in the supine position. General anesthesia was administered by anesthesiology staff who remained in attendance. The right side of the neck was prepped and draped in the usual sterile fashion. Under ultrasound guidance, the right internal jugular vein was accessed using a 21 gauge micropuncture needle and an 0.018 inch guidewire was passed. The needle was exchanged for a 4.5 French vascular introducer. The 0.018 inch guidewire was removed and replaced with an 0.035 inch Bentson guidewire . The vascular introducer was exchanged for a 5 French specialty catheter (from a transjugular intrahepatic access set) which was used to cannulate the hepatic vein. CO2 portogram was performed to define the portal system. The right hepatic vein was selected and after several attempts, the right portal vein was successfully accessed using a transjugular needle and a guidewire was passed. The tract between the right hepatic vein and the right portal vein was dilated with a balloon catheter and a repeat venogram was obtained. The TIPS coduit was stented with two 10mm X 68mm Wallstents . The measured pre-Tips pressure gradient was 16 mm Hg and the corresponding post-TIPS value was 6 mmHg. An excellent immediate post-TIPS result was documented. The vascular introducer was removed and hemostasis was obtained at the puncture site by direct compression. The patient tolerated the procedure well, was hemodynamically stable throughout the entire procedure and was successfully extubated .


Dr. [], the attending interventional radiologist, was present for the critical portions of the procedure and reviewed all images obtained.


Impression:


1. Small liver with hepatopetal flow.


2. Minimal varices.


3. Successful creation of TIPS shunt between the right hepatic vein and the right portal vein. Pre-TIPS and post-TIPS pressure gradients were 16 mm Hg and 6 mm Hg, respectively.