LIVER ANATOMY APPLIED TO THE PLACEMENT OF TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNTS

PURPOSE: To study the vascular and biliary liver anatomy and its relevance to the creation of a transjugular intrahepatic portosystemic shunt (TIPS). MATERIALS AND METHODS: Acrylic casts of 25 normal human livers (necropsy specimens) were obtained. The anatomy of the hepatic veins, portal vein, hepatic artery, and bile ducts and the relationship of structures of the portal triad were evaluated. Diameters of the vessels and distances and relative position of the structures were recorded. Special attention was given to the puncture path used for TIPS. RESULTS: One right hepatic vein (RHV) was seen in 16 cases, two RHVs in one, and an accessory RHV in six. All were posterior to the portal bifurcation. The mean distance between the RHV and the portal bifurcation was 4.4 cm. In 13 cases, the path for TIPS puncture was free of major vascular and biliary structures. In 12 cases, portal, biliary, and/or arterial structures were seen in the puncture path. CONCLUSION: TIPS puncture should be performed in the posteroinferior aspect of the right portal trunk or at the posterior aspect of the bifurcation of the portal vein. Knowledge of the vascular liver anatomy is imperative to create the TIPS safely.