Portal vein: US-guided localization prior to transjugular intrahepatic portosystemic shunt placement.

Roizental, Moisés; Kane, Richard A.; Takahashi, Jin; Kruskal, Jonathan B.; Crenshaw, William B.; Perry, Laura J.; Stokes, Ken; Clouse, M E

doi:10.1148/radiology.196.3.7644659

Cited by 30 publications

(8 citation statements)

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“…However, there is no established consensus guideline for the application of anticoagulation therapy in patients with chronic portal vein occlusion and portal cavernoma [1, 3]. For management of noncirrhotic portal hypertension due to portal cavernoma, there is no sufficient data on which of the several therapeutic options is preferred [1, 4, 5].…”

Section: Introductionmentioning

confidence: 99%

Transjugular Intrahepatic Portosystemic Shunt for the Treatment of Portal Hypertension in Noncirrhotic Patients with Portal Cavernoma

Luo

Nie

Zhou

et al. 2014

Gastroenterology Research and Practice

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Background. The purpose of this study was to evaluate the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) placement in the management of portal hypertension in noncirrhotic patients with portal cavernoma. Methods. We conducted a single institution retrospective analysis of 15 noncirrhotic patients with portal cavernoma treated with TIPS placement. 15 patients (4 women and 11 men) were evaluated via the technical success of TIPS placement, procedural complications, and follow-up shunt patency. Results. TIPS placement was technically successful in 11 out of 15 patients (73.3%). Procedure-related complications were limited to a single instance of hepatic encephalopathy in one patient. In patients with successful shunt placement, the portal pressure gradient decreased from 25.8 ± 5.7 to 9.5 ± 4.2 mmHg (P < 0.001). TIPS dysfunction occurred in two patients during a median follow-up time of 45.2 months. Revision was not performed in one patient due to inadequate inflow. The other patient died of massive gastrointestinal bleeding in a local hospital. The remaining nine patients maintained functioning shunts through their last evaluation. Conclusions. TIPS is a safe and effective therapeutic treatment for noncirrhotic patients with symptomatic portal hypertension secondary to portal cavernoma.

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Section: Introductionmentioning

confidence: 99%

Transjugular Intrahepatic Portosystemic Shunt for the Treatment of Portal Hypertension in Noncirrhotic Patients with Portal Cavernoma

Luo

Nie

Zhou

et al. 2014

Gastroenterology Research and Practice

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“…These are obstacles of US guidance so that a single needle pass may not always be achieved. An average of three punctures for successful PV entry performed with US guidance was reported in 1995 by Roizental et al (9). Cohnen et al (11) described successful punctures at the first attempt in seven of 10 patients with real-time US imaging and a single needle pass under US guidance has also been reported (12).…”

Section: Discussionmentioning

confidence: 98%

“…A common method used to navigate PV puncture is US guidance (3,9,10). But even with US guidance, it is not easy to visualize structures such as the PV branch, the gallbladder, or the bile ducts, especially in patients with severe ascites and advanced liver cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

Enhancing Transjugular Intrahepatic Portosystemic Shunt Puncture by Using Three-dimensional Path Planning Based on the Back Projection of Two Two-dimensional Portographs

Adamus¹,

Pfister²,

Loose³

2009

Radiology

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The purpose of this study was to prevent transjugular intrahepatic portosystemic shunt (TIPS) puncture failure by using three-dimensional (3D) path planning. This study was approved by the institutional review board; informed consent was obtained for the TIPS procedure. In four patients, a 3D path was planned from two two-dimensional (2D) CO2 portograms obtained at projections of 0 degrees and right anterior oblique 30 degrees . This path was overlaid onto the live fluoroscopy to guide the puncture image. In three of four patients, the target vessel was entered in the first attempt. In one patient with portal vein (PV) stenosis, the PV was entered with the third pass. This method has high potential to improve safety of the procedure and to reduce intervention time.

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“…The markers also provide a constant reference point during stent deployment. Harman et al and Roizental et al report this technique to be safe and useful (14). Finally, several interventionalists use sonography as guidance during the portal vein puncture (13).…”

Section: A B Cmentioning

confidence: 99%

“…In order to decrease the number of needle passes and increase the accuracy of those passes, several methods to target the portal vein are reported including an arterial portography, a portography using a patent paraumbilical vein and an iodinated contrast wedged hepatic venography. Today carbon dioxide wedged hepatic venography is recommended as standard for portal vein branches localization (14). Maleux et al report carbon dioxide wedged hepatic venograpghy to be a safe, efficient and reliable for right and left portal vein opacification (15).…”

Section: Sonographic Assessment After Tips Placementmentioning

confidence: 99%

Sonographic evaluation of transjugular intrahepatic porto-systemic shunt

Thijs

Bielen

et al. 2013

Journal of the Belgian Society of Radiology

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The purpose of this article is to review the role of sonography before, during and after transjugular intrahepatic portosystemic shunt placement. A sonographic assessment of the liver and abdomen is recommended before the procedure. We illustrate several important sonographic findings for the echographist, which may alter the procedure approach or even preclude transjugular intrahepatic portosystemic shunt placement. The most challenging step during the procedure is the puncture of the right portal vein. Sonography can be a helpful tool in reducing the number of needle passes, thereby reducing the risk of hemorrhagic complications. Because of its non-invasive and costbenefit nature, sonography is useful for transjugular intrahepatic portosystemic shunt follow-up. A baseline study at 24 to 48 hours is recommended to discover procedure-related complications. Long-term follow-up is important to detect malfunction of the shunt. Doppler ultrasound is very accurate in detecting shunt thrombosis. however, no consensus exists on the optimal sonographic screening protocol for detecting stenosis. We describe three sonographic parameters to detect transjugular intrahepatic portosystemic shunt stenosis with high sensitivity. finally, additional sonographic parameters and potential pitfalls are provided in order to improve sensitivity.

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Portal vein: US-guided localization prior to transjugular intrahepatic portosystemic shunt placement.

Cited by 30 publications

References 0 publications

Transjugular Intrahepatic Portosystemic Shunt for the Treatment of Portal Hypertension in Noncirrhotic Patients with Portal Cavernoma

Transjugular Intrahepatic Portosystemic Shunt for the Treatment of Portal Hypertension in Noncirrhotic Patients with Portal Cavernoma

Enhancing Transjugular Intrahepatic Portosystemic Shunt Puncture by Using Three-dimensional Path Planning Based on the Back Projection of Two Two-dimensional Portographs

Sonographic evaluation of transjugular intrahepatic porto-systemic shunt

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