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Updated: Jul 19, 2025
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Published on: June 3, 2009
Safety and Feasibility of Gun-Sight Technique for Transjugular Intra-hepatic Portosystemic Shunt (TIPS) Creation
Nathan Elie Frenk1,2, Taedo Jake Choi3, Lauren Sunhye Park3
1Division of Interventional Radiology, Department of Radiology, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC, 20007, USA. nathanfrenk@gmail.com.
Purpose:
To review technical details, indications for use, success rates and complications of gun-sight technique for transjugular intra-hepatic portosystemic shunt (TIPS) creation.
Materials And Methods:
A multicenter retrospective review was performed. Forty-two TIPS procedures with gun-sight technique were identified between 2016 and 2021. Eighty-six percent of patients had portal vein thrombosis (PVT), and 21% had undergone prior failed TIPS creation. Demographics, procedure details and outcomes were reviewed. Differences between the groups, event rates and patency rates were evaluated using nonparametric two-sample Wilcoxon rank-sum (Mann-Whitney) test, Fisher's exact test, Kaplan-Meier curves, and log-rank test.
Results:
Technical success was 98%. Sixty-seven percent of subjects had transsplenic and 26% had transhepatic access for TIPS creation. Twenty-one adverse events were noted (48%), four of which were definitely related and four were probably related to the use of gun-sight technique. Early (within 90 days) thrombosis occurred in 7/41 patients (17%), all of whom had existing PVT.
Conclusion:
Gun-sight technique for TIPS creation has a high success rate in this challenging cohort of patients. While complications can occur, most of the adverse events noted were likely associated with TIPS creation itself rather than gun-sight. Early thrombosis only occurred in patients with PVT. Level of Evidence Level 4, Case Series.
