Intravascular Ultrasound for Transjugular Intrahepatic Portosystemic Shunt Creation: “TIPS” and Tricks

Abstract

How I Do It 212This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.fluoroscopic anatomy, and to provide a case-based tutorial on the techniques and benefits of IVUS guidance.

Safety and Effectiveness of a Novel Tips Access Set with Steerable Cannula in a Swine Model

“…This led to a high number of attempts (6 in the Liverty TM group and 11 in the RUPS-100 group). IVUS and intra-procedural image guidance using other modalities like 3D image overlay, indirect portography with CO 2 would allow for TIPS being performed with fewer puncture attempts [1][2][3].…”

“…The creation of a transjugular intrahepatic portosystemic shunt (TIPS) is a technically challenging endovascular procedure. Particularly, direct cannulation of the portal branch from the hepatic venous branch requires essentially multiple passes of the needle through the liver, especially in navigating complex portal venous anatomy, despite intra-procedural image guidance using intravenous ultrasound (IVUS) and other modalities like 3-dimensional (3D) image overlay, indirect portography with CO 2 [1][2][3][4]. It usually takes several attempts for the interventionalists to complete the puncture from the hepatic vein to the portal vein with currently available TIPS access sets due to the significant heterogeneity of liver volume and morphology in different patients, or distorted anatomy due to prior TIPS [5].…”

Advanced Imaging Techniques Used in Direct Portosystemic Shunt Creation in Budd-Chiari Syndrome with Complex Venous Anatomy

“…In such patients, both conventional and intravascular ultrasound (IVUS)-guided TIPS creation can be considered. Cone beam computed tomography, 10 intracardiac echocardiography (ICE), 11 a three-dimensional (3D) virtual target fluoroscopic display 12 can improve the visualization and access portal vein branches during TIPS creation in these patients with complex anatomy. In some cases, opacification of the portal vein via a percutaneous transhepatic, trans-splenic, or para-umbilical vein is used as an additional tool to improve the success rate in accessing the portal vein.…”

“…In percutaneous DIPS creation, IVUS can confirm appropriate access into the portal vein branch and the IVC and is helpful for more accurate stent deployment. IVUS is an efficient assistant tool for TIPS creation, 11 and is associated with less procedure time, radiation dose, contrast usage, and fewer needle passes. 18 In summary, real-time inspection of the anatomy and planning for potential shunt pathways by IVUS is more critical in patients with complex anatomy, where conventional fluoroscopy-guided techniques may not be helpful.…”