Ultrasound-Guided Portal Vein Access and Percutaneous Wire Placement in the Portal Vein Are Associated With Shorter Procedure Times and Lower Radiation Doses During TIPS Placement

Çam, İsa; Gencturk, Mehmet; Shrestha, Prakash; Golzarian, Jafar; Flanagan, Siobhan; Lim, Nicholas; Young, Shamar

doi:10.2214/ajr.20.23846

Cited by 16 publications

(15 citation statements)

References 20 publications

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“…In contrast, in a more recent study, the wire-targeting access technique was associated with significantly reduced fluoroscopy time when compared with the traditional CO2 portography based technique (29.5 min vs 38.9 min; p=0.005). 35 In addition, wire-targeting access required fewer needle passes (2 vs 4; p=0.039).…”

Section: Discussionmentioning

confidence: 98%

Advanced portal venous access techniques for transjugular intrahepatic portosystemic shunt placement

Partovi

Shwaiki

et al. 2021

BMJ Open Gastroenterol

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IntroductionTransjugular intrahepatic portosystemic shunt (TIPS) placement is a well-established but technically challenging procedure for the management of sequelae of end-stage liver disease. Performed essentially blindly, traditional fluoroscopically guided TIPS placement requires multiple needle passes and prolonged radiation exposure to achieve successful portal venous access, thus increasing procedure time and the risk of periprocedural complications. Several advanced image-guided portal access techniques, including intracardiac echocardiography (ICE)-guided access, cone-beam CT (CBCT)-guided access and wire-targeting access techniques, can serve as alternatives to traditional CO2 portography-based TIPS creation.MethodsA literature search was performed on the electronic databases including MEDLINE and Embase, from 2000 to the present to identify all relevant studies. The reference list also included studies identified manually, and studies referenced for other purposes.FindingsThe main benefit of these advanced access techniques is that they allow the operator to avoid essentially blind portal punctures, and the ability to visualise the target, thus reducing the number of required needle passes. Research has shown that ICE-guided access can decrease the radiation exposure, procedure time and complication rate in patients undergoing TIPS placement. This technique is particularly useful in patients with challenging portal venous anatomy. However, ICE-guided access requires additional equipment and possibly a second operator. Other studies have shown that CBCT-guided access, when compared with traditional fluoroscopy-guided access, provides superior visualisation of the anatomy with similar amount of radiation exposure and procedure time. The wire-targeting technique, on the other hand, appears to offer reductions in procedure time and radiation exposure by enabling real-time guidance. However, this technique necessitates percutaneous injury to the liver parenchyma in order to place the target wire.ConclusionAdvanced portal access techniques have certain advantages over the traditional fluoroscopically guided TIPS access. To date, few studies have compared these advanced guided access options, and further research is required.

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Section: Discussionmentioning

confidence: 98%

Advanced portal venous access techniques for transjugular intrahepatic portosystemic shunt placement

Partovi

Shwaiki

et al. 2021

BMJ Open Gastroenterol

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“…It is possible that the lack of complementary ultrasound guidance contributed to the technical challenges encountered, especially in the setting of PLSVC. Transabdominal ultrasound is another option for portal venous access guidance and also has been shown to reduce procedure times and radiation doses (Cam et al 2020;Tavare et al 2017), and likely more readily available and cost effective than intravascular ultrasound.…”

Section: Discussionmentioning

confidence: 99%

Transjugular intrahepatic portosystemic shunt creation via isolated persistent left superior vena cava: a case series

et al. 2020

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Background Isolated persistent left superior vena cava (PLSVC) is a rare vascular anatomic variant, which can be an incidental finding at the time of an endovascular procedure. Case presentation This report describes the technical success, adverse events, and clinical outcomes of transjugular intrahepatic portosystemic shunt (TIPS) creation via isolated PLSVC. Three adult patients with cirrhosis and isolated PLSVC underwent TIPS placement successfully with one major adverse event. Two patients required TIPS revision within 90 days. There were no deaths within 90 days. Conclusions TIPS creation via isolated PLSVC is feasible using standard techniques with a left jugular vein approach. Caution is warranted during the procedure to assess for any aberrant drainage pattern to the left atrium and to prepare for potentially challenging instrument navigation through the coronary sinus.

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“… 2,6 This reported technical success rate is 95%, 6 however, failure occurs, typically at the intrahepatic puncture step, which is relatively blind in the traditional technique. 7 Knowledge of alternative techniques may increase the success rate, particularly in the setting of challenging anatomy or limited resources.…”

Section: Introductionmentioning

confidence: 99%

“…Techniques to guide the intrahepatic needle pass can be broadly classified into wedge portal venography, ultrasound needle guidance (intravascular or transhepatic), and portal vein targeting (insertion of a wire, snare, or balloon), with published series demonstrating a decreased number of needle passes with use of these adjuncts. 7,8 Direct intrahepatic portocaval shunt (DIPS) has gained popularity over recent years and can be performed as a salvage or primary technique, however, may contraindicate certain liver transplant techniques. 9–12 …”

Section: Introductionmentioning

confidence: 99%

Modified gun-sight transjugular intrahepatic portosystemic shunt technique

Lukies

Phan

2022

BJR

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Objectives: Conventional transjugular intrahepatic portosystemic shunt (TIPS) stent insertion is an established procedure with high rates of technical success. However, alternative techniques may increase success rates in the setting of challenging anatomy or limited resources. Originally described as a salvage porto-caval approach, we present a modified gun-sight porto-hepatic TIPS technique. Methods: A retrospective review was performed identifying patients who underwent modified gun-sight TIPS over a 1 year period. Six procedures were identified, with snares opened in the target hepatic and portal veins, fluoroscopic percutaneous transhepatic puncture through the snares, and wire pulled through-and-through to establish a parenchymal tract. Five modified gun-sight procedures were primary, and one was salvage. Results: All modified gun-sight TIPS procedures were technically successful with a single needle pass, with patency and appropriate haemodynamic flow at 2 weeks. Advantages of the technique include fluoroscopic-guided transhepatic puncture utilising typically on-shelf low-cost equipment, without requiring a dedicated TIPS set or endovascular ultrasound. Disadvantages include liver capsular puncture. Conclusions: The modified gun-sight TIPS technique is an alternative approach utilising typically on-shelf and low-cost equipment for a targeted fluoroscopic-guided parenchymal puncture. Advances in knowledge: The presented technique is an initial description of a novel alternative TIPS technique, which may be useful to consider in challenging cases.

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Ultrasound-Guided Portal Vein Access and Percutaneous Wire Placement in the Portal Vein Are Associated With Shorter Procedure Times and Lower Radiation Doses During TIPS Placement

Cited by 16 publications

References 20 publications

Advanced portal venous access techniques for transjugular intrahepatic portosystemic shunt placement

Advanced portal venous access techniques for transjugular intrahepatic portosystemic shunt placement

Transjugular intrahepatic portosystemic shunt creation via isolated persistent left superior vena cava: a case series

Modified gun-sight transjugular intrahepatic portosystemic shunt technique

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