Intracardiac Echocardiography–Guided TIPS: A Primer for New Operators

Grimsbo, Matthew C.; Brown, Matthew A.; Lindquist, J.; Schramm, Kristofer; Kirkpatrick, Daniel; Ryu, Robert K.; Trivedi, Premal S.

doi:10.1055/s-0040-1715875

Cited by 10 publications

(8 citation statements)

References 15 publications

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“…This procedure helps reduce elevated portal pressure in patients with intrahepatic causes of portal hypertension. 18 TIPS has demonstrated safety and clinical effectiveness in pediatric patients for managing acute variceal hemorrhage or preventing rebleeding from gastroesophageal varices. 19 In cases where varices persist after TIPS creation, additional procedures may be required during transhepatic portal vein access.…”

Section: Salvaging Anatomical Liver With Portosystemic Shuntsmentioning

confidence: 99%

Role of Interventional Radiology in the Management of Liver Transplant Complications in Children

Shah,

Sharma,

Variyam

et al. 2024

Digestive Disease Interventions

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Liver transplantation (LT) is a common solid organ transplant in the pediatric population. The common indications for LT, as well as its complications, differ between adults and children. This difference necessitates unique pediatric interventional radiology (IR) interventions. This article focuses on unique vascular complications occurring post-pediatric LT and highlights the importance of IR in their management. It explores IR's involvement in the workup of patients' pre-LT and management of complications following portosystemic shunts. We discuss advantages and disadvantages of different access routes as well as the prevalence, clinical picture, diagnosis, and management of complications after pediatric LT. These complications encompass portal vein stenosis, portal vein thrombosis, hepatic artery stenosis, hepatic artery thrombosis, hepatic artery pseudoaneurysm, arterioportal fistula, hepatic vein stenosis, and inferior vena cava stenosis. The choice of endovascular technique for a clinical indication depends on vascular anatomy, time since LT, and patient-specific factors. Transsplenic access is a useful alternative to transhepatic or transjugular access. The decision to place a stent in a child is influenced by the expected growth of the child and risk of focal narrowing at stent edge (because of recipient growth). Technical challenges in pediatric patient management, including uncooperative patients and sedation issues, must be considered. Pediatric LT complications can present with significant challenges in the posttransplant care of recipients and may lead to serious morbidity and graft failure if not managed effectively. IR techniques like balloon angioplasty, stent placement, thrombolysis, and embolization have demonstrated success in treating these complications, improving patient outcomes, and reducing long-term morbidity and mortality. By enhancing the understanding of medical practitioners and interventional radiologists about complex vascular complications, this article aims to contribute to better posttransplant care and improved outcomes for LT in pediatric populations. Continued collaboration between specialties and research will advance the field of pediatric LT and IR, to create even more effective treatment strategies.

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Section: Salvaging Anatomical Liver With Portosystemic Shuntsmentioning

confidence: 99%

Role of Interventional Radiology in the Management of Liver Transplant Complications in Children

Shah,

Sharma,

Variyam

et al. 2024

Digestive Disease Interventions

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“…Previous research has suggested that the dual systems can be used by a single operator when obtaining two tandem accesses through the same internal jugular vein. 27 …”

Section: Discussionmentioning

confidence: 99%

“…Previous research has suggested that the dual systems can be used by a single operator when obtaining two tandem accesses through the same internal jugular vein. 27 In comparison to ICE-guided TIPS placement, fewer data are available regarding CBCT-guided and wire-targeting techniques for TIPS creation. With regard to CBCT-guided TIPS creation, one of the first reported cases was in a patient with polycystic liver disease, a condition that has been considered a relative contraindication for the procedure because of an elevated risk of bleeding.…”

Section: Discussionmentioning

confidence: 99%

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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“…ICE may facilitate portal vein entry and has also been shown to reduce radiation dose, contrast volume, procedural duration, and number of needle passes. [6][7][8] A 9-Fr venous access sheath is required to accommodate the ICE catheter, and either a tandem access site in the right internal jugular vein or a separate common femoral vein access is used. Although common femoral vein access is usually technically simpler, this approach requires two operators, one to manipulate the ICE catheter and a second to drive the TIPS needle.…”

Section: Intravascular Echocardiography Guidancementioning

confidence: 99%

“…ICE may facilitate portal vein entry and has also been shown to reduce radiation dose, contrast volume, procedural duration, and number of needle passes. 6 7 8…”

Section: Indirect Visualization Of the Portal Veinmentioning

confidence: 99%

Advanced Techniques for Accessing the Portal Vein during Transjugular Intrahepatic Portosystemic Shunt Creation

Sinha

Goldman

Patel

et al. 2023

Semin intervent Radiol

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Transjugular portosystemic shunt (TIPS) placement is a widely accepted method for reducing portal pressures in conditions including symptomatic varices, refractory ascites, hepatic hydrothorax, portomesenteric thrombosis, and Budd-Chiari syndrome. The traditional method for performing TIPS involves “blind” access into a portal vein branch from a hepatic vein, typically right portal vein to right hepatic vein, using preoperative imaging and intraoperative wedged portography for guidance. However, standard access technique may not always be feasible due to occluded portal or hepatic veins, distorted anatomy, or prior TIPS. In this article we discuss alternative techniques for accessing the portal vein for TIPS placement when standard methods are not sufficient.

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Intracardiac Echocardiography–Guided TIPS: A Primer for New Operators

Cited by 10 publications

References 15 publications

Role of Interventional Radiology in the Management of Liver Transplant Complications in Children

Role of Interventional Radiology in the Management of Liver Transplant Complications in Children

Advanced portal venous access techniques for transjugular intrahepatic portosystemic shunt placement

Advanced Techniques for Accessing the Portal Vein during Transjugular Intrahepatic Portosystemic Shunt Creation

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