Transjugulärt

Transjugulärt, or transjugular in English, describes medical procedures that access the vascular system through the internal jugular vein, usually the right internal jugular vein, to reach central venous, hepatic, or portal venous structures. This access route is used by interventional radiologists and hepatologists for diagnostic or therapeutic purposes when peripheral puncture or abdominal access carries high bleeding risk or is technically difficult.

Common applications include transjugular liver biopsy, where a catheter is threaded from the internal jugular vein into the hepatic veins and through the liver parenchyma to obtain a tissue sample; transjugular intrahepatic portosystemic shunt (TIPS), a procedure that creates a channel within the liver between a hepatic vein and a portal vein to reduce portal hypertension; and transjugular venography or embolization, where venous structures are opacified or treated via neck access. The transjugular approach can also facilitate other endovascular procedures requiring venous access through the neck.

Advantages of the transjugular route include a lower risk of bleeding into the peritoneal cavity or liver capsule in patients with coagulopathy or ascites, and avoidance of traversing abdominal organs. Limitations include technical complexity, longer procedure time, potential neck vein complications, and, for some tasks, smaller biopsy samples. Specific risks may include venous thrombosis, infection, hematoma, or hepatic encephalopathy after TIPS.

Historically developed to enhance safety in liver disease, transjugular access remains a standard option in interventional radiology and hepatology. Related approaches include transhepatic and femoral venous access.