Radiation exposure during transjugular intrahepatic portosystemic shunt creation in patients with complete portal vein thrombosis or portal cavernoma

Current knowledge and management of portal vein thrombosis in cirrhosis

“…The presence of portal cavernoma or an inability to identify the intrahepatic portal trunk or intrahepatic portal vein branches markedly increases the technical difficulties of TIPS creation. These procedures are technically challenging and radiation intensive 123 ; despite this, an increasing number of these patients have undergone successful TIPS placement as familiarity with this procedure grows. In patients with cavernoma, the recanalisation of the portal vein remnant should be preferred to the placement of a stent in a collateral vessel as the latter poses an increased risk of haemoperitoneum and is less effective for portal system decompression.…”

Transjugular Intrahepatic Portosystemic Shunt in Chronic Portal Vein Thrombosis—From Routine Recommendations to Demanding Scenarios

“…Simultaneous ultrasound guidance allows the operator to access the thrombosed native portal vein. Use of this route not only reduces the procedure time and associated risks of prolonged radiation exposure but avoids several other potentially life-threatening complications of TIPS such as capsular transgression and hemoperitoneum, inadvertent puncture of an artery or periportal collateral vessels, biliary injury, and access site complications (in cases of transhepatic or trans-splenic approach) [ 17 ]. The need for an extra set of expert hands for ultrasound guidance and unfavorable body habitus in some patients remains a drawback.…”

Transjugular Intrahepatic Portosystemic Shunt in Nonmalignant Noncirrhotic Portal Vein Thrombosis and Portosinusoidal Vascular Disorder

“…It allows for precise puncturing of intrahepatic portal branches that are thrombosed in cases where the thrombosis extends into these branches. Additionally, in patients with portal cavernoma, it enables the selective puncturing of the intrahepatic portal branch that communicates with the remnant of the portal vein, enhancing the effectiveness and safety of the TIPS creation procedure [ 39 ]. The combined transjugular/transhepatic, transjugular/transplenic or transjugular/transmesenteric approaches have been reported for TIPS creation in NNPVT patients after conventional transjugular approach failure or as a first-line approach [ 36 , 39 , 40 , 41 , 42 , 43 ].…”

“…Additionally, in patients with portal cavernoma, it enables the selective puncturing of the intrahepatic portal branch that communicates with the remnant of the portal vein, enhancing the effectiveness and safety of the TIPS creation procedure [ 39 ]. The combined transjugular/transhepatic, transjugular/transplenic or transjugular/transmesenteric approaches have been reported for TIPS creation in NNPVT patients after conventional transjugular approach failure or as a first-line approach [ 36 , 39 , 40 , 41 , 42 , 43 ]. On note, due to the paucity of data present in the literature, no clear recommendation can be given about the use of a transhepatic, transplenic or transmesenteric approach in such cases.…”