Intravascular US-Guided Portal Vein Access: Improved Procedural Metrics during TIPS Creation

Area of Science:

• Interventional Radiology
• Vascular Surgery
• Medical Imaging

Background:

• Transjugular intrahepatic portosystemic shunt (TIPS) creation is a critical procedure for managing portal hypertension.
• Optimizing image guidance for portal vein (PV) access during TIPS is essential for procedural efficiency and patient safety.

Purpose of the Study:

• To compare the outcomes and procedural metrics of TIPS creation using three distinct image guidance techniques for PV access.
• To evaluate the efficacy of intravascular ultrasound (US) guidance against fluoroscopic and marker wire guidance.

Main Methods:

• Retrospective review of 68 patients undergoing TIPS procedures over 28 months.
• Stratification of patients based on PV access guidance: fluoroscopy (n=26), marker wire (n=18), or intravascular US (n=24).
• Analysis of procedural outcomes, radiation exposure, contrast volume, and procedure duration.

Main Results:

• No significant differences in technical success, hemodynamic success, or complication rates among the three guidance groups.
• Intravascular US guidance significantly reduced fluoroscopy time, air kerma, contrast volume, and total procedure time compared to fluoroscopic guidance.
• Intravascular US guidance also reduced fluoroscopy time and contrast volume compared to marker wire guidance.

Conclusions:

• Intravascular US guidance is effective for PV access during TIPS creation, particularly in challenging anatomies.
• This technique offers significant advantages by reducing radiation exposure, contrast agent volume, and overall procedure duration.