Intravascular Ultrasound Guidance for TIPS Procedures: A Review

Area of Science:

• Interventional Radiology
• Medical Imaging
• Hepatology

Background:

• Transjugular intrahepatic portosystemic shunt (TIPS) creation is crucial for managing portal hypertension.
• Obtaining adequate portal vein (PV) access is a technically demanding and time-consuming step in TIPS procedures.
• Conventional fluoroscopic guidance lacks real-time visualization, often necessitating multiple passes and leading to complications.

Purpose of the Study:

• To review current intravascular ultrasound (IVUS) technology for TIPS procedures.
• To describe the technical aspects of IVUS-guided TIPS creation.
• To discuss the clinical indications, benefits, and supporting evidence for IVUS in TIPS.

Main Methods:

• Review of current literature and technology related to IVUS-guided TIPS.
• Description of the procedural technique for IVUS application during TIPS creation.
• Analysis of clinical outcomes and evidence supporting IVUS use.

Main Results:

• IVUS provides direct, real-time visualization of hepatic structures and PV puncture targets.
• IVUS guidance improves procedural metrics: reduced radiation dose, contrast volume, and procedure time.
• IVUS enhances technical success rates, especially in complex cases like portal vein thrombosis or variant anatomy.

Conclusions:

• IVUS guidance offers an improved safety profile and higher success rates for TIPS placement compared to conventional methods.
• IVUS facilitates precise PV access, mitigating risks associated with blind punctures.
• IVUS-guided TIPS has the potential to become the standard of care for TIPS procedures.