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Analyzing Radiation Use during Transjugular Intrahepatic Portosystemic Shunt Creation.

Daniel H Kwak1, Raja S Ramaswamy2, Michael Harrod2

  • 1Department of Clinical Sciences, University of Central Florida College of Medicine, Orlando, Florida.

Journal of Vascular and Interventional Radiology : JVIR
|October 7, 2020
PubMed
Summary

Intravascular ultrasound (US) guidance significantly reduces radiation exposure during transjugular intrahepatic portosystemic shunt (TIPS) procedures. This method offers a safer alternative for portal vein access in TIPS creation.

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Area of Science:

  • Interventional Radiology
  • Medical Imaging
  • Hepatology

Background:

  • Transjugular intrahepatic portosystemic shunt (TIPS) creation is a critical procedure for managing portal hypertension.
  • Portal vein access is a key step in TIPS, often involving significant radiation exposure.
  • Minimizing radiation dose is crucial for patient and operator safety during interventional procedures.

Purpose of the Study:

  • To compare radiation metrics during portal vein access for TIPS using conventional versus intravascular ultrasound (US) guidance.
  • To evaluate the impact of different guidance techniques on radiation exposure during TIPS procedures.

Main Methods:

  • Retrospective analysis of 11 patients undergoing TIPS creation.
  • Measurement of radiation metrics including kerma area product and reference point air kerma.
  • Comparison of radiation exposure between conventional and intravascular US-guided portal vein access.

Main Results:

  • Intravascular US-guided TIPS creation showed significantly lower kerma area product (8.4 mGy cm² vs 54.8 mGy cm²), reference point air kerma (29.5 mGy vs 210.4 mGy), and fluoroscopy times (8.9 min vs 19.1 min) compared to conventional methods.
  • Wedged hepatic venography was identified as a major contributor to radiation exposure.
  • P values were < .05 for all significant differences, indicating statistical significance.

Conclusions:

  • Intravascular US guidance is associated with substantially reduced radiation exposure during the portal vein access phase of TIPS creation.
  • This technique offers a safer and more efficient approach to TIPS procedures, minimizing patient and staff radiation dose.
  • Further adoption of intravascular US guidance in TIPS procedures is recommended to enhance safety and reduce cumulative radiation exposure.