Gun-Sight Technique for Transjugular Intrahepatic Portosystemic Shunt Creation: Two Case Reports and Review of the...

Transjugular intrahepatic portosystemic shunt (TIPS) creation is an established treatment for complications of portal hypertension; however, the procedure can be technically challenging in patients with distorted vascular anatomy or severe hepatic fibrosis. Conventional techniques may fail to achieve portal vein access in certain patients; therefore, various modifications have been introduced to improve success rates. We present two cases of successful TIPS creation using the gun-sight technique, which entails placing snares in the hepatic and portal veins, followed by percutaneous needle advancement under fluoroscopic guidance to traverse both snares. This study also discusses the advantages, limitations, and technical considerations of the gun-sight technique through a literature review.