Direct intrahepatic portocaval shunt

Area of Science:

• Interventional Radiology
• Vascular Surgery
• Hepatology

Background:

• Portal hypertension management often requires shunting procedures.
• Transjugular intrahepatic portosystemic shunt (TIPS) is a common treatment.
• Limitations in TIPS durability and patient selection exist.

Purpose of the Study:

• To describe the direct intrahepatic portacaval shunt (DIPS) procedure.
• To detail indications, technique, and outcomes of DIPS.
• To facilitate adoption of DIPS by experienced interventional radiologists.

Main Methods:

• DIPS is a modification of TIPS using intravascular ultrasound (IVUS) and fluoroscopy.
• IVUS-guided puncture from the inferior vena cava to the portal vein.
• Placement of a polytetrafluoroethylene-covered stent graft to create the shunt.

Main Results:

• DIPS aims to enhance shunt patency durability.
• The procedure expands the range of patients eligible for endovascular portocaval shunting.
• Outcomes data are presented to guide clinical practice.

Conclusions:

• DIPS is a viable modification of TIPS for portal hypertension.
• The technique offers potential for improved long-term shunt function.
• Interventional radiologists can integrate DIPS into their practice for select patients.