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

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• 作者：Matthew G. Gipson ; MD^a ; ^{matthew.gipson@ucdenver.edu" class="auth_mail" title="E-mail the corresponding author} ; Mitchell T. Smith ; MD^a ; Janette D. Durham ; MD^a ; Anthony Brown ; MD^a ; Thor Johnson ; MD ; PhD^a ; Charles E. Ray Jr ; MD ; PhD^b ; Rajan K. Gupta ; MD^a ; Kimi L. Kondo ; DO^a ; Paul J. Rochon ; MD^a ; Robert K. Ryu ; MD^a
• 关键词：AK ; air kerma ; BSC ; Budd&ndash ; Chiari syndrome ; DAP ; dose&ndash ; area product ; PSG ; portosystemic gradient ; PV ; portal vein ; RA ; right atrial ; TIPS ; transjugular intrahepatic portosystemic shunt
• 刊名：Journal of Vascular and Interventional Radiology
• 出版年：2016
• 出版时间：August 2016
• 年：2016
• 卷：27
• 期：8
• 页码：1140-1147
• 全文大小：153 K

文摘

To evaluate transjugular intrahepatic portosystemic shunt (TIPS) outcomes and procedure metrics with the use of three different image guidance techniques for portal vein (PV) access during TIPS creation.

Materials and Methods

A retrospective review of consecutive patients who underwent TIPS procedures for a range of indications during a 28-month study period identified a population of 68 patients. This was stratified by PV access techniques: fluoroscopic guidance with or without portography (n = 26), PV marker wire guidance (n = 18), or intravascular ultrasound (US) guidance (n = 24). Procedural outcomes and procedural metrics, including radiation exposure, contrast agent volume used, procedure duration, and PV access time, were analyzed.

Results

No differences in demographic or procedural characteristics were found among the three groups. Technical success, technical success of the primary planned approach, hemodynamic success, portosystemic gradient, and procedure-related complications were not significantly different among groups. Fluoroscopy time (P = .003), air kerma (P = .01), contrast agent volume (P = .003), and total procedural time (P = .02) were reduced with intravascular US guidance compared with fluoroscopic guidance. Fluoroscopy time (P = .01) and contrast agent volume (P = .02) were reduced with intravascular US guidance compared with marker wire guidance.

Conclusions

Intravascular US guidance of PV access during TIPS creation not only facilitates successful TIPS creation in patients with challenging anatomy, as suggested by previous investigations, but also reduces important procedure metrics including radiation exposure, contrast agent volume, and overall procedure duration compared with fluoroscopically guided TIPS creation.