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Modified gun-sight transjugular intrahepatic portosystemic shunt technique
Matthew Lukies1,2, Heather Moriarty1,3, Tuan Phan1
1Department of Radiology, Alfred Health, Melbourne, VIC, Australia.
The British Journal of Radiology
|September 5, 2022
Summary
A modified gun-sight transjugular intrahepatic portosystemic shunt (TIPS) technique offers a low-cost, fluoroscopic-guided alternative for challenging cases. This novel approach achieved technical success in all procedures, demonstrating its potential utility.
Area of Science:
- Interventional Radiology
- Hepatology
- Vascular Surgery
Background:
- Conventional transjugular intrahepatic portosystemic shunt (TIPS) stent insertion is a standard procedure with high technical success rates.
- Alternative techniques are valuable for cases with challenging anatomy or limited resources.
- The modified gun-sight porto-hepatic TIPS technique is presented as a novel approach.
Purpose of the Study:
- To describe and evaluate a modified gun-sight porto-hepatic TIPS technique.
- To assess the feasibility and technical success of this alternative TIPS approach.
Main Methods:
- A retrospective review of six patients who underwent modified gun-sight TIPS over one year.
- The technique involves opening snares in hepatic and portal veins, fluoroscopic percutaneous transhepatic puncture through snares, and establishing a parenchymal tract.
- Procedures were either primary (five) or salvage (one).
Main Results:
- All modified gun-sight TIPS procedures were technically successful with a single needle pass.
- Patency and appropriate hemodynamic flow were confirmed at two weeks.
- Advantages include the use of on-shelf, low-cost equipment and fluoroscopic guidance, avoiding the need for dedicated TIPS sets or endovascular ultrasound.
Conclusions:
- The modified gun-sight TIPS technique is a viable alternative approach for targeted fluoroscopic-guided parenchymal puncture.
- It utilizes readily available, low-cost equipment.
- This technique may be particularly useful in challenging TIPS cases.
