From the Guidelines
The recommended needle size for a Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedure in the liver is typically a 5-Fr or 6.3-Fr needle, as part of the Rosch-Uchida transjugular liver access set, for initial liver parenchymal puncture 1.
Key Considerations
- The choice of needle size may depend on the patient's age and size, with particular attention needed for children under 2 years old or weighing less than 10 kg 1.
- The use of a covered stent with a diameter of 8–10 mm is commonly recommended, with an average final dilation of 7–8 mm, to reduce the risk of variceal bleeding recurrence 1.
- A small diameter TIPS (8 mm) may be favored, followed by progressive dilation if needed, to minimize the risks of overshunting and offer procedural uniformity 1.
Technical Approach
- A 10-Fr or 12-Fr introducer sheath is typically used, with a 10-mm or 12-mm diameter balloon catheter for dilation of the intrahepatic tract.
- The use of carbon dioxide or iodinated contrast as a contrast agent is recommended to facilitate visualization during the procedure.
- A multidisciplinary discussion is essential to choose between TIPS and other treatment options, considering factors such as the patient's liver function, cardiovascular and renal comorbidities, and response to medical treatment 1.