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

Gipson, Matthew G.; Smith, Mitchell T.; Durham, Janette D.; Brown, Anthony; Johnson, Thor; Ray, Charles E.; Gupta, Rajan; Kondo, Kimi L.; Rochon, Paul J.; Ryu, Robert K.

doi:10.1016/j.jvir.2015.12.002

Cited by 38 publications

(22 citation statements)

References 14 publications

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“…Doppler imaging may be prudent to ensure portal venous patency in individuals who cannot undergo CT or MR imaging. As a final note, use of intravascular ultrasound guidance for TIPS creation[111213] provides an additional means for IR operators to identify and target portal vein branches during TIPS procedures and may render some of the more challenging anatomic cases technically easier given the ability to visualize and puncture vessels with real-time observation.…”

Section: Discussionmentioning

confidence: 99%

Anatomic Variations of the Right Portal Vein: Prevalence, Imaging Features, and Implications for Successful Transjugular Intrahepatic Portosystemic Shunt Creation

Gunasekaran

Gaba

2017

Journal of Clinical Imaging Science

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Given the widespread use of transjugular intrahepatic portosystemic shunt (TIPS) creation for the treatment of portal hypertensive complications, a working knowledge of portal venous anatomy is critical for interventional radiologists. The right portal vein – which is most commonly accessed during TIPS – is subject to various anatomic variants that may potentially impact procedure success. This pictorial essay characterizes the anatomic patterns of the right portal vein branching in terms of type and frequency based on case series review. The work also explains the potential procedural implications of the right portal vein anatomic variations as they pertain to TIPS technical success.

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Section: Discussionmentioning

confidence: 99%

Anatomic Variations of the Right Portal Vein: Prevalence, Imaging Features, and Implications for Successful Transjugular Intrahepatic Portosystemic Shunt Creation

Gunasekaran

Gaba

2017

Journal of Clinical Imaging Science

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“…Analysis of fluoroscopy time (minute), dose area product (µGy Ã m 2 ), air kerma or cumulative dose (mGy), and total procedural time (minute) showed these technical factors to be significantly less in TIPS with ICE compared with conventional TIPS cases which used marker wires or fluoroscopy for guidance. 10 Specifically, Gipson et al showed a median air kerma of 1,442 and 1,421 mGy in TIPS using fluoroscopy or marker wires, respectively, compared with 850 mGy when ICE was used. 10 Patients undergoing TIPS placement for cirrhosis often have a myriad of sequelae related to liver disease.…”

Section: Intravascular Ultrasound With Intracardiac Echocardiography mentioning

confidence: 99%

“…10 Specifically, Gipson et al showed a median air kerma of 1,442 and 1,421 mGy in TIPS using fluoroscopy or marker wires, respectively, compared with 850 mGy when ICE was used. 10 Patients undergoing TIPS placement for cirrhosis often have a myriad of sequelae related to liver disease. Concomitant renal disease, in particular, may be an indication for TIPS (e.g., hepatorenal syndrome) or a complicating factor in TIPS creation requiring judicious use of iodinated contrast.…”

Section: Intravascular Ultrasound With Intracardiac Echocardiography mentioning

confidence: 99%

New Techniques and Devices in Transjugular Intrahepatic Portosystemic Shunt Placement

RiChard

Thornburg

2018

Semin intervent Radiol

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Recently, new techniques and devices in transjugular intrahepatic portosystemic shunt (TIPS) placement have emerged that can improve upon the standard procedure. Ultrasound guidance during TIPS with intracardiac echocardiography (ICE), placement of controlled expansion (CX) stents, and portal vein recanalization (PVR) via transsplenic access are three techniques with new data supporting their implementation. ICE guidance can improve the technical success of difficult cases, decrease procedure time, and decrease complications such as capsular puncture, hemobilia, and hepatic artery injury. CX stents offer the operator better control over the final portosystemic gradient, which is particularly useful in patients with a high risk of post-TIPS hepatic encephalopathy. Finally, transsplenic access provides a stable, antegrade route for PVR, which can be used to optimize transplant candidacy as well as treat the sequelae of portal hypertension in patients with portal vein thrombosis. This article will describe the benefits, technical parameters, and patient selection criteria for each of these new techniques.

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“…Some centers have found success with transhepatic or trans-splenic placement of marker wires within the portal veins as a target for needle puncture. 17 One of the drawbacks of this technique is the additional needle puncture through highly vascular organs with associated risks of hemorrhage and organ damage. Due to the risks, many operators perform embolization along the tract.…”

Section: Portal Venous Accessmentioning

confidence: 99%

“…The first of the three reports described a series of TIPS cases that were performed using conventional (n = 26), marker wire (n = 18) and IVUS (n = 24) guidance. 17 Marker wire cases involved transhepatic or trans-splenic placement of an 0.018 inch wire into the portal vein through a 21 gauge Chiba needle using fluoroscopic and percutaneous ultrasound guidance. Cases were performed with the Colapinto needle from a right internal jugular access.…”

Section: Current Literaturementioning

confidence: 99%

A review of recent experience with transjugular intrahepatic portosystemic shunt creation using intravascular ultrasound

Kao

Lee

2018

Int J Gastrointest Interv

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Portal vein access has historically been the most technically challenging step in the creation of transjugular intrahepatic portosystemic shunts (TIPSs). The use of intravascular ultrasound (IVUS) for guidance of portal vein access during TIPS creation has garnered much interest in recent years. Recent literature has suggested potential improvements in procedural metrics that may result from use of IVUS for TIPS. This review aims to provide historical context, detail technical advances and describe recent clinical experience with the use of IVUS for TIPS creation.

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

Cited by 38 publications

References 14 publications

Anatomic Variations of the Right Portal Vein: Prevalence, Imaging Features, and Implications for Successful Transjugular Intrahepatic Portosystemic Shunt Creation

Anatomic Variations of the Right Portal Vein: Prevalence, Imaging Features, and Implications for Successful Transjugular Intrahepatic Portosystemic Shunt Creation

New Techniques and Devices in Transjugular Intrahepatic Portosystemic Shunt Placement

A review of recent experience with transjugular intrahepatic portosystemic shunt creation using intravascular ultrasound

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