BACKGROUND: Transjugular intrahepatic portosystemic shunt (TIPS) placement is an effective treatment method for a number of complications of portal hypertension. While this complex procedure has been firmly established in treatment algorithms, more data is needed to determine the most efficient and safest ways to perform the procedure.
OBJECTIVE: To determine the effect on procedure efficiency of three different techniques of portal vein cannulation during TIPS placement.
METHODS: Medical records of patients who underwent TIPS between 2005 and 2019 were reviewed. Patients were grouped based on portal vein access technique, as follows: Group 1 (G1) transabdominal ultrasound-guided; Group 2 (G2) fluoroscopic guidance with wedged-hepatic portography; Group 3 (G3) percutaneous portal vein guidewire placement for fluoroscopic targeting.
RESULTS: A total of 264 patients who underwent TIPS were subdivided into G1 (n=54/264 [20.5%]), G2 (n=172/264 [65.1%]) and G3 (n=38/264 [14.4%]). Mean fluoroscopic time (minutes) in G1 (34.8 ± 16.6) did not differ from G2 (38.9 ± 20.8, p=0.09) or G3 (29.5 ± 14.6, p=0.06). However, G2 patients had significantly longer fluoroscopic times than G3 (p=0.005). Total anesthesia time (minutes) in G1 (190.2 ± 45.6) did not differ from G2 (199.7 ± 59.5, p=0.15). However, G3 had significantly shorter anesthesia time (162.6 ± 39.7 minutes) than both G1 (p=0.003) and G2 (p<0.001). The mean contrast volume was significantly lower in G1 than in G2 (67.9 ± 36.8 mL vs 87.1 ± 42.9 mL, p=0.005). More intrahepatic needle passes (median, [IQR]) were required in G2 (4 [1-7]) compared with G1 (2 [1-4], p=0.004) and G3 (2 [1-4.25], p=0.039). When complications in G1 and G3 were pooled, this cohort had significantly fewer complications than G2 (p=0.013).
CONCLUSION: US-guided portal vein access and percutaneous portal vein guidewire placement for fluoroscopic targeting during TIPS placement are associated with shorter procedure and fluoroscopic times and potentially decreased complications.
CLINICAL IMPACT: This study helps interventional radiologists understand the safest and most efficient way to access the portal vein, a key step during TIPS placement.
Bibliographical notePublisher Copyright:
© 2021 American Roentgen Ray Society. All rights reserved.
- Imaging guidance
- Portal hypertension
- Portal vein puncture
- Ultrasonography, Interventional/methods
- Portal Vein/diagnostic imaging
- Middle Aged
- Radiation Dosage
- Operative Time
- Portasystemic Shunt, Transjugular Intrahepatic/instrumentation
PubMed: MeSH publication types
- Journal Article