Portal venous branch targeting with a platinum-tipped wire to facilitate transjugular intrahepatic portosystemic shunt (TIPS) procedures

Teitelbaum, G P; Allan, Richard J. Van; Reed, Richard A.; Hanks, Sue E.; Katz, Michael

doi:10.1007/bf02641894

Cited by 36 publications

(9 citation statements)

References 5 publications

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“…The success in puncture using this technique is largely dependent on the experience of the operator. More invasive techniques include the use of a targeting guidewire or catheters inserted into the portal vein, placed via an enlarged umbilical vein or transhepatically [2,8]. This method is relatively invasive and should be avoided in patients with coagulopathy.…”

Section: Discussionmentioning

confidence: 99%

Hepatic artery-targeting guidewire technique during transjugular intrahepatic portosystemic shunt

Yamagami

Tanaka²,

Yoshimatsu³

et al. 2011

BJR

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Objective: This study evaluated the feasibility and safety of the transjugular intrahepatic portosystemic shunt (TIPS) procedure using the hepatic artery-targeting guidewire technique for the puncture step. Methods: We retrospectively reviewed 11 consecutive patients (5 men and 6 women, aged 46-76 years (mean 64 years)) with portal hypertension in whom the TIPS procedure was performed. As the first step in the TIPS procedure in all cases, a micro-guidewire was inserted into the hepatic arterial branch accompanying the portal venous branch through a microcatheter coaxially advanced from a 5-French catheter positioned in the coeliac or common hepatic artery. At the puncture step, the tip of the metallic cannula was aimed 1 cm posterior to the distal part of this micro-guidewire, after which the TIPS procedure was performed. Success rate, number of punctures and complications were evaluated. Results: The TIPS procedure was successfully performed in all 11 patients. The mean number of punctures until success in entering the targeted portal venous branch was 5 (range 1-14). In 3 patients (27%), the right portal venous branch was entered at the first puncture attempt. The hepatic artery was punctured once in one patient and the bile duct was punctured once in another patient. No serious procedure-induced complications occurred. Conclusion: The TIPS procedure can be accomplished safely, precisely and relatively easily using the hepatic artery-targeting guidewire technique. [2,3]. In many institutions, including ours, however, this procedure is rarely performed and it might be difficult to maintain the necessary skills.During the TIPS procedure, the puncture from the proximal portion of the hepatic vein (usually a right hepatic vein) to the proximal portion of a branch of the intrahepatic portal vein (usually the right portal vein) is the most important and difficult step [1,2]. In 1994, Matsui et al [4] introduced a simple technique to assist in this puncture step. This technique was aided by a targeting guidewire in the hepatic arterial branch accompanying the portal venous branch to be punctured. To our knowledge, there has been no subsequent literature on the use of this simple technique, which we have adopted in our institution. This study evaluated the application of the hepatic artery-targeting guidewire technique for the puncture step of the TIPS procedure. We also assessed the occurrence of procedure-induced complications in order to clarify the value of this technique to inexperienced or infrequent operators such as those in our institution. Methods and materials PatientsBetween January 2004 and July 2009, 11 consecutive patients (5 men and 6 women aged 46-76 years (mean 64 years)) with portal hypertension underwent the TIPS procedure at our institution. For these patients, the hepatic artery-targeting guidewire technique was utilised for the puncture step of the TIPS procedure. ProceduresAll procedures were performed after the patient provided written informed consent. The consent form included permission fo...

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Section: Discussionmentioning

confidence: 99%

Hepatic artery-targeting guidewire technique during transjugular intrahepatic portosystemic shunt

Yamagami

Tanaka²,

Yoshimatsu³

et al. 2011

BJR

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“…Arterial portography is another technique of navigation but requires intra-arterial injection of contrast, and visualization of portal vein may be suboptimal, particularly when the vein is small in caliber or shows hepatofugal flow[ 221 ]. Many studies have described computed tomography or ultrasound -guided percutaneous marking of portal vein using guidewires or metallic coils, which is not without risk in patients with advanced cirrhosis[ 222 , 223 ]. The use of transabdominal ultrasound-guided portal vein puncture (Figure 7 ) overcomes these problems and has been shown to reduce the radiation dose[ 224 ].…”

Section: Update On the Technical Aspects Of Tipsmentioning

confidence: 99%

Transjugular intrahepatic portosystemic shunt in cirrhosis: An exhaustive critical update

Rajesh

George

Philips

et al. 2020

WJG

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More than five decades after it was originally conceptualized as rescue therapy for patients with intractable variceal bleeding, the transjugular intrahepatic portosystemic shunt (TIPS) procedure continues to remain a focus of intense clinical and biomedical research. By the impressive reduction in portal pressure achieved by this intervention, coupled with its minimally invasive nature, TIPS has gained increasing acceptance in the treatment of complications of portal hypertension. The early years of TIPS were plagued by poor long-term patency of the stents and increased incidence of hepatic encephalopathy. Moreover, the diversion of portal flow after placement of TIPS often resulted in derangement of hepatic functions, which was occasionally severe. While the incidence of shunt dysfunction has markedly reduced with the advent of covered stents, hepatic encephalopathy and instances of early liver failure continue to remain a significant issue after TIPS. It has emerged over the years that careful selection of patients and diligent post-procedural care is of paramount importance to optimize the outcome after TIPS. The past twenty years have seen multiple studies redefining the role of TIPS in the management of variceal bleeding and refractory ascites while exploring its application in other complications of cirrhosis like hepatic hydrothorax, portal hypertensive gastropathy, ectopic varices, hepatorenal and hepatopulmonary syndromes, non-tumoral portal vein thrombosis and chylous ascites. It has also been utilized to good effect before extrahepatic abdominal surgery to reduce perioperative morbidity and mortality. The current article aims to review the updated literature on the status of TIPS in the management of patients with liver cirrhosis.

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“…Teitelbaum et al 11 described a technique involving placement of a platinum-tipped guidewire in a portal venous branch as a target for fluoroscopic transvenous access to facilitate TIPS placement. The wire-targeting technique is particularly useful for patients with cirrhosis, as the distorted parenchymal architecture can render transvenous access from a hepatic venous branch to a portal venous branch difficult.…”

Section: Wire-targeting Techniquementioning

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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Portal venous branch targeting with a platinum-tipped wire to facilitate transjugular intrahepatic portosystemic shunt (TIPS) procedures

Cited by 36 publications

References 5 publications

Hepatic artery-targeting guidewire technique during transjugular intrahepatic portosystemic shunt

Hepatic artery-targeting guidewire technique during transjugular intrahepatic portosystemic shunt

Transjugular intrahepatic portosystemic shunt in cirrhosis: An exhaustive critical update

Advanced portal venous access techniques for transjugular intrahepatic portosystemic shunt placement

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