Intrahepatic portosystemic shunt creation from a femoral venous approach

A 47-year-old man with advanced portal hypertension was refractory to conservative therapy. Decompression of the portal system by placement of a portosystemic shunt was considered as a temporizing method in anticipation of a liver transplant. Due to variant hepatic venous anatomy, placement of a portosystemic shunt through the jugular approach was not possible. After careful planning and preprocedural imaging, an intrahepatic portosystemic shunt was successfully created from a femoral venous approach. This procedure was technically feasible; however, technical difficulties related to the design of the available access needle were encountered.