Personalized Approach for Cardiovascular Procedures During Percutaneous Transhepatic Intravascular Interventions

Background: /Objective: There is still insufficient awareness of the potential use of percutaneous transhepatic intravascular access during cardiovascular interventions. This study aimed to evaluate the anatomy of the hepatic and portal veins, verify existing literature descriptions of percutaneous accesses to the hepatic veins, and explore the best transhepatic vascular approaches for each individual. Methods: We recruited 100 healthy volunteers who underwent sonographic evaluation of their hepatic and portal veins anatomy. The percutaneous transhepatic vascular access was assessed according to cardiological guidelines. New potential access points to the hepatic and portal veins were also evaluated. Results: Ultrasonographic evaluation of hepatic and portal veins anatomy was successfully performed in all examinations. According to cardiological guidelines, the middle hepatic vein was the most reliable structure for visualizing direction in both in-plane and out-of-plane projections. Sonographic assessment of the optimal puncture site for hepatic or portal vein access achieved a 100% success rate. The most reliable alternative puncture sites for transhepatic intravascular access were identified as follows: the middle hepatic vein at the 7th intercostal space along the midclavicular line, using a transducer positioned upward at a 60-degree angle, and the right hepatic vein at the 9th intercostal space along the posterior axillary line, also using a 60-degree upward transducer angle. Conclusions: Understanding variations in hepatic and portal veins anatomy is essential for determining the most precise access points for intravascular interventions. Ultrasonographic examination identifies more suitable personalized transhepatic access points than previously described anatomic landmarks.