sbreen
New
Procedure Performed:
Ultrasound-guided access of the right internal jugular vein
Portacavogram
Intravascular ultrasound evaluation of the portal vein, portacaval shunt and inferior vena cava.
Portal vein percutaneous angioplasty and deployment of a 10 x 60 mm self-expanding stent placement
Portacaval shunt angioplasty and deployment of 8 x 39 mm and 8 x 29 mm Gore-Tex VBX covered stent graft placement.
Procedure: Upon identification of the patient, the patient is kept supine on the operating table. Standard sterile preparations done after sedation by anesthesia. Local anesthesia given with 1% lidocaine. Right internal jugular vein was accessed with an ultrasound using a SonoSite. I accessed that with a micropuncture needle then changed what to a 4-French sheath. I injected a contrast material, confirmed the intravenous location of the catheter. The right internal jugular vein draining well into the right atrium. At this point, I gradually dilated and inserted a 10-French arrow high support sheath uneventfully. I gave her 3000 units of IV heparin to prevent any incidental thrombosis. Then, I advances the wire into the portacaval shunt by using the IM catheter. I managed to cross into the portacaval shunt and beyond the total occlusion and entered into the patent portal vein. Then, I kept the IM catheter further down into the portal vein and dis a portacavogram and that showed the portal vein is patent but the shunt is chronically occluded. I could see large gastric varices as well. At this point, we gave another 2000 units of IV heparin. Then I did an IVUS evaluation, showed the stent graft is chronically occluded right from the inferior vena cava, and both covered and bare metal stent of Viatorr stent graft is occluded and, in fact, there is an area of the portal vein occlusion beyond the bare metal stent as well. I deployed an 8 x 39 mm Viabahn covered stent graft into the proximal part of the sent graft right at the inferior vena cava and the another 8 x 29 mm Gore-Tex VBX covered stent graft into the distal part of the portacaval shunt. Then in the bare metal area of the sent I put a 10 x 60 mm self-expanding stent starting from the patent portal vein into the stent graft. I did a post angioplasty with an 8 mm balloon. I did IVUS evaluation with showed an established flow back into the stent graft, and I count not do any gradient because the machine broke right at the point of testing. I did a portavavogram with showed a partial flow into the stent graft, it is not adequate, but I could not proceed any further because of the radiation exposure we had by this time. And so I accepted a partially opened stent graft as the final result. I am going tore-evaluate her with her clinical status.
Ultrasound-guided access of the right internal jugular vein
Portacavogram
Intravascular ultrasound evaluation of the portal vein, portacaval shunt and inferior vena cava.
Portal vein percutaneous angioplasty and deployment of a 10 x 60 mm self-expanding stent placement
Portacaval shunt angioplasty and deployment of 8 x 39 mm and 8 x 29 mm Gore-Tex VBX covered stent graft placement.
Procedure: Upon identification of the patient, the patient is kept supine on the operating table. Standard sterile preparations done after sedation by anesthesia. Local anesthesia given with 1% lidocaine. Right internal jugular vein was accessed with an ultrasound using a SonoSite. I accessed that with a micropuncture needle then changed what to a 4-French sheath. I injected a contrast material, confirmed the intravenous location of the catheter. The right internal jugular vein draining well into the right atrium. At this point, I gradually dilated and inserted a 10-French arrow high support sheath uneventfully. I gave her 3000 units of IV heparin to prevent any incidental thrombosis. Then, I advances the wire into the portacaval shunt by using the IM catheter. I managed to cross into the portacaval shunt and beyond the total occlusion and entered into the patent portal vein. Then, I kept the IM catheter further down into the portal vein and dis a portacavogram and that showed the portal vein is patent but the shunt is chronically occluded. I could see large gastric varices as well. At this point, we gave another 2000 units of IV heparin. Then I did an IVUS evaluation, showed the stent graft is chronically occluded right from the inferior vena cava, and both covered and bare metal stent of Viatorr stent graft is occluded and, in fact, there is an area of the portal vein occlusion beyond the bare metal stent as well. I deployed an 8 x 39 mm Viabahn covered stent graft into the proximal part of the sent graft right at the inferior vena cava and the another 8 x 29 mm Gore-Tex VBX covered stent graft into the distal part of the portacaval shunt. Then in the bare metal area of the sent I put a 10 x 60 mm self-expanding stent starting from the patent portal vein into the stent graft. I did a post angioplasty with an 8 mm balloon. I did IVUS evaluation with showed an established flow back into the stent graft, and I count not do any gradient because the machine broke right at the point of testing. I did a portavavogram with showed a partial flow into the stent graft, it is not adequate, but I could not proceed any further because of the radiation exposure we had by this time. And so I accepted a partially opened stent graft as the final result. I am going tore-evaluate her with her clinical status.