Transjugular intrahepatic portosystemic shunt placement: portal vein puncture guided by 3D/2D image registration of contrast-enhanced multi-detector computed tomography and fluoroscopy

Abstract

Background To assess the technical feasibility, success rate, puncture complications and procedural characteristics of transjugular intrahepatic portosystemic shunt (TIPS) placement using a three-dimensional vascular map (3D-VM) overlay based on image registration of pre-procedural contrast-enhanced (CE) multi-detector computed tomography (MDCT) for portal vein puncture guidance. Materials and methods Overall, 27 consecutive patients (59 ± 9 years, 18male) with portal hypertension undergoing elective TIPS procedure were included. TIPS was guided by CE-MDCT overlay after image registration based on fluoroscopic images. A 3D-VM of the hepatic veins and the portal vein was created based on the pre-procedural CE-MDCT and superimposed on fluoroscopy in real-time. Procedural characteristics as well as hepatic vein catheterization time (HVCT), puncture time (PT), overall procedural time (OPT), fluoroscopy time (FT) and the dose area product (DAP) were evaluated. Thereafter, HVCT, PT, OPT and FT using 3D-VM (61 ± 9 years, 14male) were compared to a previous using classical fluoroscopic guidance (53 ± 9 years, 21male) for two interventional radiologist with less than 3 years of experience in TIPS placement. Results All TIPS procedure using of 3D/2D image registered 3D-VM were successful with a significant reduction of the PSG (p < 0.0001). No clinical significant complication occurred. HVCT was 14 ± 11 min, PT was 14 ± 6 min, OPT was 64 ± 29 min, FT was 21 ± 12 min and DAP was 107.48 ± 93.84 Gy cm2. HVCT, OPT and FT of the interventionalist with less TIPS experience using 3D/2D image registered 3D-VM were statistically different to an interventionalist with similar experience using fluoroscopic guidance (pHVCT = 0.0022; pOPT = 0.0097; pFT = 0.0009). PT between these interventionalists was not significantly different (pPT = 0.2905). Conclusion TIPS placement applying registration-based CE-MDCT vessel information for puncture guidance is feasible and safe. It has the potential to improve hepatic vein catherization, portal vein puncture and radiation exposure.

Percutaneous Transsplenic Balloon-Assisted Transjugular Intrahepatic Portosystemic Shunt Placement in Patients with Portal Vein Obliteration for Portal Vein Recanalization: Feasibility, Safety and Effectiveness

“…In this period, 14 patients presented with chronic PVO defined as [ 95% occlusion of the PV with or without portal cavernoma and PVT [ 27 days after onset of symptoms [3,7]. All patients underwent a standardized pre-and postinterventional workflow as described before and were included in the study [8].…”

“…Finally, a 0.035-inch guidewire was introduced through the transjugular access in the superior mesenteric vein or SV and a standard TIPS placement with a TIPS stent graft (GORE Viatorr TIPS Endoprosthesis with controlled Expansion, W.L.Gore&Associates) was performed (Fig. 2) [8].…”

“…Patient demographics and procedural characteristics including the complication profile according the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) classification system were obtained from medical reports [8,9]. The overall procedural time (OPT), fluoroscopy time (FT) and the dose-area product (DAP) were determined as defined elsewhere [8].…”

“…Patient demographics and procedural characteristics including the complication profile according the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) classification system were obtained from medical reports [8,9]. The overall procedural time (OPT), fluoroscopy time (FT) and the dose-area product (DAP) were determined as defined elsewhere [8]. Furthermore, the splenic access time (SAT) as the puncture time of the SV confirmed by contrast media or an established guidewire in the SV branch and the balloon positioning time (BPT) as following the time until inflation of the balloon catheter as fluoroscopic target were assessed from interventional imaging.…”

Safety and feasibility of transjugular intrahepatic portosystemic shunt in elderly patients with liver cirrhosis and refractory ascites

“…TIPS placement was performed by clinically experienced interventional radiologists (BCM, JBH and TCM) according to the institutional standard operating procedure [20,21]. In all patients covered stents (Viatorr 1 , Gore, Flagstaff, Arizona, AZ, USA) with a prosthesis diameter of 8 mm (n = 151) or 10 mm (n = 9) or were used.…”