Rups 100

Local disinfection and anesthesia were performed at the selected piercing site, and then jugular vein puncture was conducted. A liver access set (RUPS-100; Cook, USA) was delivered into the hepatic vein or hepatic inferior vena cava, the left and right trunk of the portal vein or portal vein bifurcation were punctured, and the liver access set was then placed in the portal vein. A pigtail catheter was used for portography and measurement of portal venous pressure. The leading end of the ultra-smooth ultra-long hard guide wire was placed in the superior mesenteric vein or splenic vein. The sheath of the liver access set was withdrawn into the preshunt channel in the liver parenchyma, and biopsy forceps (Minimally Invasive Medical Technology Co., LTD, Nanjing, China) were inserted through the sheath to obtain liver tissue of the preshunt channel in the liver parenchyma (the size range of each obtained liver tissue sample ranged from 0.4×0.4 cm² to 0.8×0.8 cm², and recollection of tissue was required for samples of a smaller size) (Figure 1-A1). A balloon was introduced along the guide wire to dilate the shunt, and then a covered stent (Bard Fluency) with a diameter of 8 mm was implanted (Figures 1-A2 and 1-A3), followed by stent dilation (Figure 1-A4), measurement of portal venous pressure, and portography.

TIPS creation was performed by experienced interventional radiologists. Catheterization of the hepatic vein was implemented through the right internal jugular vein with a transjugular liver access set (RUPS-100; Cook Inc.). Then a TIPS needle was used to puncture the portal vein under fluoroscopic guidance. After successful puncture of the portal vein with a TIPS needle, a hydrophilic guidewire (Terumo, Tokyo, Japan) was sequentially introduced into the main portal vein, superior mesenteric vein or splenic vein. After the intrahepatic tract was dilated with a balloon catheter, an 8 mm ePTFE-covered stent (Fluency; Bard Corporation or Viabahn; Gore Corporation) was placed in the intrahepatic duct. Measurement of portal pressure gradient (PPG) was performed before and after shunt establishment. The target value of PPG was below 12 mmHg or, alternatively, a reduction of at least 20% from the baseline^{13 (link)}. For varicose vein embolization, coil and tissue glue were used to close the varicose veins. Balloon tamponade was used when massive bleeding occurred.

All the procedures were completed by 2–3 experienced gastroenterology intervention doctors in this institution. The process of the TIPS procedure has been described in detail in previous articles (9 (link)). Briefly, the right or middle hepatic vein was catheterized using a transjugular venous approach with RUPS-100 (COOK; Indiana, United States) under local anesthesia. Indirect portal venography was performed through the superior mesenteric artery or the splenic artery. After showing the portal vein, the portal vein from the hepatic vein was punctured. After successful puncture, a 6–8-mm diameter covered stent (Fluency; Bard, New Jersey, United States or Viatorr; W.L. Gore & Associates, Arizona, United States) or a covered stent combined with a bare metal stent (Fluency; Bard with Luminexx; Bard), was deployed into the tract to support the parenchymal channel.,Then the stent was dilated with a balloon catheter. If evident stomach and esophageal varices presented, embolization was performed to fill the residual varices with coils or tissue-adhesive glue. Portal pressure gradient (PPG) was measured before and after the shunt procedure. All the operations were completed by the same intervention team. Blood pressure and heart rate were measured during operation.

Transjugular intrahepatic portal shunt is performed by the same team of experienced physicians. The right internal jugular vein was punctured with rosch-uchida transjugular liver access set (RUPS)-100 (Cook Inc.; Bloomington, USA) puncture device, intubated to the hepatic vein through the vena cava, and the portal vein was punctured under fluoroscopy to establish the direct channel between the hepatic vein and the portal vein. Then, portasystemic shunt was established by balloon expansion (6-8 mm) and the stents were placed. All patients in this study were treated with membrane-covered stents to maintain long-term patency of stents.^{5 (link)} Placing a bare stent (Bard E-LUMINEXX Vascular Stent, Karlsruhe, Germany) followed by placing a coated stent (Fluency; Bard Inc., USA or Viabahn; Gore, USA). Portal vein pressure gradient (PPG) was measured before and after the shunt was established.