Transjugular intrahepatic portosystemic shunt with transhepatic portal vein puncture guided by ultrasound: a technical alternative

Abstract

Evaluation of an alternative technique to perform transjugular intrahepatic portosystemic shunt (TIPS), using abdominal ultrasound to guide portal puncture. Methods Retrospective analysis of TIPS performed from January 2014 to December 2018 in an interventional radiology service. TIPS were performed according to the classic technique, except at the moment of portal branch puncture, when abdominal ultrasound was used to guide it, visualized its path within the parenchyma in real-time. Qualitative and quantitative variables were analyzed considering a 95% confidence interval and application of the Student's t-test with a significance level of P < 0.05. Results Forty-one TIPS were performed. The technical success rate of ultrasound guidance in portal puncture was 100.0%. After its performance, a reduction in the portosystemic pressure gradient was observed, with an initial gradient average of 18.8 mmHg (12-25 ± 3.6 mmHg) and a final gradient of 9.2 mmHg (5-14 ± 2.4 mmHg). The mean values for the TIPS execution time, fluoroscopy time and the radiation dose, verified through the dose area product, were 65.2 ± 46.7 min, 25 ± 14.1 min and 85.6 ± 70 Gy cm 2 , respectively. There were no complications related to the inadvertent puncture of nontarget structures or deaths due to complications resulting from TIPS. ConclusionThe results demonstrate that the portal transhepatic puncture guided by the abdominal ultrasound is an effective and safe procedure and results in time of execution, time of fluoroscopy and radiation dose below the current reference values of the conventional procedure.

Transjugular intrahepatic portosystemic shunt in decompensated cirrhotic patients in a tertiary hospital in southern Brazil

“…TIPS were performed under anesthesia, using the Philips Allura XP ® angiograph, Rösch-Uchida ® (Cook) access set and noncovered prosthesis, according to the classic technique 14 , except at the puncture of the portal branch, when abdominal ultrasound (Sonosite ® ) was performed to assist the correct positioning 15 . Once the hepatic vein was already catheterized and the portal venous branch was identified, the path of the puncture needle was followed from the hepatic vein along its way in the parenchyma until it reached the portal vein branch in real time, adjusting its direction as required.…”