Carbon dioxide‐based portography: An alternative to conventional imaging with the use of iodinated contrast medium

Maruyama, Hitoshi; Okugawa, Hidehiro; Ishibashi, Hiroyuki; Takahashi, Masanori; Kobayashi, Satoshi; Yoshizumi, Hiroaki; Yokosuka, Osamu

doi:10.1111/j.1440-1746.2010.06248.x

Cited by 7 publications

(9 citation statements)

References 26 publications

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“…However, it is not fully mixed and enters the left and right branches of the portal vein. The right branch mainly receives superior mesenteric venous blood, while the left branch mainly receives blood from the splenic vein[7,8]. We hypothesized that targeted puncture of the left portal vein would divert the non-nutritive blood from the splenic vein into the TIPS shunt and reduce the incidence of HE.…”

Section: Discussionmentioning

confidence: 99%

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Targeted puncture of left branch of intrahepatic portal vein in transjugular intrahepatic portosystemic shunt to reduce hepatic encephalopathy

Luo

Chu

Huang

et al. 2019

WJG

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BACKGROUND Transjugular intrahepatic portosystemic shunt (TIPS) is currently used for the treatment of complications of portal hypertension. The incidence of hepatic encephalopathy (HE) remains a problem in TIPS placement. It has been reported that the right branch mainly receives superior mesenteric venous blood while the left branch mainly receives blood from the splenic vein. We hypothesized that targeted puncture of the left portal vein would divert the non-nutritive blood from the splenic vein into the TIPS shunt; therefore, targeted puncture of the left branch of the intrahepatic portal vein during TIPS may reduce the risk of HE. AIM To evaluate the influence of targeted puncture of left branch of portal vein in TIPS on HE. METHODS A retrospective analysis of 1244 patients with portal-hypertension-related complications of refractory ascites or variceal bleeding who underwent TIPS from January 2000 to January 2013 was performed. Patients were divided into group A (targeting left branch of portal vein, n = 937) and group B (targeting right branch of portal vein, n = 307). TIPS-related HE and clinical outcomes were analyzed. RESULTS The symptoms of ascites and variceal bleeding disappeared within a short time. By the endpoint of follow-up, recurrent bleeding and ascites did not differ significantly between groups A and B ( P = 0.278, P = 0.561, respectively). Incidence of HE differed significantly between groups A and B at 1 mo (14.94% vs 36.80%, χ 2 = 4.839, P = 0.028), 3 mo (12.48% vs 34.20%, χ 2 = 5.054, P = 0.025), 6 mo (10.03% vs 32.24%, χ 2 = 6.560, P = 0.010), 9 mo (9.17% vs 31.27%, χ 2 = 5.357, P = 0.021), and 12 mo (8.21% vs 28.01, χ 2 = 3.848, P = 0.051). There were no significant differences between groups A and B at 3 years (6.61% vs 7.16%, χ 2 = 1.204, P = 0.272) and 5 years (5.01% vs 6.18%, χ 2 = 0.072, P = 0.562). The total survival rate did not differ between groups A and B ( χ 2 = 0.226, P = 0.634, log-rank test). CONCLUSION Targeted puncture of the left branch of the intrahepatic portal vein during TIPS may reduce the risk of HE ...

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Section: Discussionmentioning

confidence: 99%

“…However, it is not fully mixed and enters the left and right branches of the portal vein. The right branch mainly receives superior mesenteric venous blood while the left branch mainly receives blood from the splenic vein[8].…”

Section: Introductionmentioning

confidence: 99%

Targeted puncture of left branch of intrahepatic portal vein in transjugular intrahepatic portosystemic shunt to reduce hepatic encephalopathy

Luo

Chu

Huang

et al. 2019

WJG

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“…CO 2 is found to be superior to ICA for this use and can be used as first line contrast agent for portography[22]. The reason is buoyancy and low viscosity of CO 2 making it travelling through the sinusoids easily and deeply.…”

Section: Introductionmentioning

confidence: 99%

Use of carbon dioxide as an intravascular contrast agent: A review of current literature

Ali¹,

Mangi²,

Rehman³

et al. 2017

WJC

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Use of X-ray contrast allows us to differentiate between two or more adjacent structures on radiographic studies. The X-ray contrast agent can be the one with increase X-ray absorption, like iodine and a barium X-ray contrast agent or the one with decrease X-ray absorption like air and carbon dioxide contrast agent. Each contrast agent possesses different risks and benefits in various ways. Carbon dioxide as an intravascular contrast agent can be used as an alternative intravascular contrast agent and has superior results in some cases. In patients with renal dysfunction or iodinated contrast allergy, the use of Iodinated Contrast Agent poses the risk of considerable morbidity. Similarly, use of Gadolinium is discouraged in subject with severe renal dysfunction. Use of carbon dioxide (CO2) as an intravascular contrast, offers an alternative in such patients for certain procedures, as it is not nephrotoxic and it does not incite allergic reactions. It is inexpensive, readily available and due to its unique physical properties, it can be used to image a wide variety of vascular beds and chambers. The aim of this paper is to systemically review the current literature to describe the indications, contraindications, adverse effects, instruments, precautions, latest methodologies and data supporting for the use of CO2 as a contrast agent.

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“…However, it was not fully balanced and entered the left and right branches of the portal vein. The right branch mainly receives blood from the superior mesenteric vein and the left branch, mainly from the splenic vein 22 . Furthermore, ammonia concentration in the blood is mostly localized in the superior mesenteric vein, and the main cause of HE is high blood ammonia concentration.…”

Section: Discussionmentioning

confidence: 99%

Clinical efficacy of transjugular intrahepatic portosystemic shunt created through left or right branches of the portal vein: A meta-analysis

Zhai

Cui

Dong

et al. 2021

Journal of Interventional Medicine

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Carbon dioxide‐based portography: An alternative to conventional imaging with the use of iodinated contrast medium

Abstract: Carbon dioxide may be a first-line contrast material for evaluating portal vein images by PTP.

Cited by 7 publications

References 26 publications

Targeted puncture of left branch of intrahepatic portal vein in transjugular intrahepatic portosystemic shunt to reduce hepatic encephalopathy

Targeted puncture of left branch of intrahepatic portal vein in transjugular intrahepatic portosystemic shunt to reduce hepatic encephalopathy

Use of carbon dioxide as an intravascular contrast agent: A review of current literature

Clinical efficacy of transjugular intrahepatic portosystemic shunt created through left or right branches of the portal vein: A meta-analysis

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