This study aims to investigate the spatial relationship, puncture path distance, and plane overlap between hepatic veins and portal vein in simulated transjugular intrahepatic portosystemic shunt (TIPS) procedures based on CT images, in order to improve the success rate of puncture procedure during TIPS.

This retrospective study was conducted from December 2023 and April 2024 in patients with cirrhosis, who underwent abdominal contrast-enhanced CT. A Right-Anterior-Superior three-dimensional spatial coordinate system was established to analysis the spatial relationship and distance between middle or right hepatic vein (points A) and right portal trunk (point B). The spatial positions, puncture path distance between the hepatic vein puncture point (point A) and the portal vein puncture point (point B) during TIPS, as well as the plane overlap between point A and the right portal vein branch, were statistically analyzed.

A total of 84 cirrhotic patients were analyzed retrospectively. Point B was more frequently located posterior to point A when the middle hepatic vein was chosen as point A compared to the right hepatic vein (P<0.05). When choosing middle hepatic vein as point A, the puncture path distance path would be shorter (P<0.05). Additionally, the plane overlap was greater when the middle hepatic vein was selected as point A than when the right hepatic vein was chosen (P<0.05).

Based on CT images of cirrhotic patients, puncturing the origin of the right portal vein branch via the middle hepatic vein results in a shorter puncture path and higher plane overlap compared to using the right hepatic vein. These findings have the potential to improve the success rate of puncture techniques during TIPS procedures and reduce puncture-related complications.