What is the initial access site for the TIPSS procedure?

The initial access site for the Transjugular Intrahepatic Portosystemic Shunt (TIPSS) procedure is the internal jugular vein. This choice is based on several factors related to the anatomical considerations and procedural requirements for TIPSS.

The internal jugular vein is located close to the neck and has direct access to central venous circulation. By accessing this vein, interventional radiologists can effectively introduce a catheter into the central venous system, which is essential for navigating through the right atrium and into the inferior vena cava, ultimately reaching the desired hepatic veins. This route minimizes the risk of complications associated with deeper venous access and facilitates the necessary imaging and intervention needed to create the shunt between the portal and hepatic venous systems.

Other access sites, such as the femoral vein, subclavian vein, or radial artery, may be utilized in other vascular procedures, but they are not standard for TIPSS. The femoral vein, while large and easily accessible, does not provide the optimal trajectory to reach the hepatic veins without additional manipulation. Similarly, the subclavian vein has a more complicated anatomy and positioning, which could introduce potential risks during the TIPSS procedure. Radial artery access is associated with peripheral vascular interventions