To introduce the technical protocol and clinical application of percutaneous transhepatic intrahepatic portosystemic shunt (PTIPS).

Between November 2009 and March 2013, 76 patients with symptomatic portal hypertension underwent PTIPS due to bleeding varices (n=69), refractory ascites (n=7), and bleeding varices combining with refractory ascites (n=23). The severity of liver disease was Child-Pugh A in 23 cases, Child-Pugh B in 35, and Child-Pugh C in 18. The CT or MR image manifested serious hepatatrophy in 34 cases and cavernous transformation of portal vein (CTPV) in 25 cases. Under fluoroscopic guidance, the portal vein (PV) was punctured . Then, the hepatic vein (HV) or retrohepatic inferior vena cava (RIVC) was punctured PTIPS procedure was completed in the standard transjugular fashion.

The procedure was technically successful in all patients. And effective portal decompression and free antegrade shunt flow were achieved. The mean portal pressure gradient decreased from (32.35±2.89) mmHg to (18.42±1.32) mmHg before and after PTIPS creation respectively, and the difference was significant statistically (P<0.001). Of the 76 patients, abdominal hemorrhage occurred in 2 cases, which was cured by artery embolization. One patient developed hepatic coma and died after 5 days while the other 75 patients survived and the symptoms of portal hypertension disappeared in one month.

PTIPS is both safe and effective in treatment of portal hypertension with exceptionally challenging anatomy. It is an available supplement for transjugular intrahepatic portosystemic shunt. It can extend the application scope of interventional portosystemic shunt.