In Reply to: Re: Case 1097_02 -- Portal vein thrombosis in the setting of acute pancreatitis: treatment with portal reconstruction posted by Scott Trerotola on October 20, 1997 at 17:17:39:
I have some thoughts and some questions. My opinion is that the transjugular approach for a case like this is not a prudent approach. I feel that when we use a TJ approach during TIPS, we actually perforate the capsule much more often than we know, and we get away with it because the liver is so fibrous and devascularized that significant bleeding is uncommon. A TJ approach for biopsy can obviously be much more controlled.
In addition to the factors favoring a transheptic approach previously discussed, I would like to suggest that a TH approach might actually have a decreased likelihood of leading to severe bleeding. This patient's liver might be normal and very well vascularized. With a TH approach, at least I know where I have breeched the capsule, and I know that I have breeched it only once. I can even choose to embolize my tract on the way out.
Any comments regarding the above are very welcome. (Please tell me that I am not the only person who has drawn back ascitic fluid during a TIPS.)