China is a large country with liver diseases, and a variety of liver diseases will eventually lead to portal hypertension causing patients to develop intractable ascites, ruptured esophagogastric fundic varices and bleeding, which seriously endanger the health of our people. Transjugular intrahepatic portosystemic shunt (TIPS) has been widely used in clinical practice as an important treatment for portal hypertension and its complications, and has become one of the main clinical treatment methods. However, the clinic often encounters special patients with extremely complicated portal hypertension, such as portal vein spongiosis, portal vein thrombosis and occlusion due to splenectomy, etc. Patients are mostly no longer able to receive surgical treatment, and even the opportunity of liver transplantation is lost. In the past, the traditional TIPS procedure had high risk in this regard and the success rate of the procedure was extremely low, which made most patients lose their lives because they could not receive effective treatment. In response to this clinical problem, the Department of Interventional Vascular Surgery, with the support and cooperation of our strong sister departments of hepatology, hepatic surgery and gastroenterology, under the leadership of Vice President Shan Hong and Director Jiang Zaibo, after years of clinical exploration and repeated research, has repeatedly improved the traditional TIPS technique and created the first percutaneous transhepatic percutaneous intrahepatic portosystemic shunt (PTIPS) in China, and achieved satisfactory clinical The clinical efficacy of PTIPS has been satisfactory, which makes our department always in the leading position in the interventional treatment of portal hypertension domestically and internationally. PTIPS is based on the traditional TIPS technique, but the puncture access has been changed, making the most difficult portal vein puncture in TIPS procedure simple, easy and safe. Since PTIPS is a fine needle puncture, and the puncture process is done in the liver parenchyma, it has the advantages of low surgical risk, high success rate and wide range of indications compared with the traditional TIPS technique, and for complex patients who cannot be completed by conventional TIPS, individualized puncture plan can be developed based on the technical idea of this method to complete the intrahepatic portal shunt. Using PTIPS, our department has successfully performed intrahepatic portosystemic shunts for more than 20 patients with complex portal hypertension both inside and outside the hospital, all of whom were successful. Patient 1, male, 38 years old, Budd-Chiari syndrome (diffuse occlusion type of hepatic vein), recurrent abdominal distension and gastrointestinal bleeding was ineffective by conservative internal medicine treatment. The patient visited several well-known hospitals in Beijing and Shanghai for several times, but was not effectively treated due to the overly complicated condition. Preoperative CT: hepatic stasis, poorly visualized hepatic vein, spongy portal vein (A). Percutaneous puncture of the hepatic vein showed no normal branches (B); percutaneous puncture portal venogram showed portal vein spongiosis and portal vein pressure of 50 cm water column (C). A modified PTIPS procedure was performed, and a repeat angiogram showed patency with a portal vein pressure of 30 cm water column (D). Repeat ultrasound showed patency of blood flow in the stent (E). Patient 2, male, 34 years old, with portal vein thrombosis and portal vein spongiosis, had recurrent symptoms of gastrointestinal bleeding such as vomiting blood and black stool in the past 1 year, and repeatedly underwent endoscopic variceal sclerosis and splenic artery embolization in and out of the hospital. Preoperative CT showed complete occlusion of the main trunk of the portal vein and extensive cavernous changes. Our department successfully performed intrahepatic portosystemic shunt using modified PTIPS for this patient. He recovered well after the operation, and his quality of life improved significantly, and the stent was rechecked several times. Department of Interventional Vascular 2012-03-16