Radiation Exposure in Transjugular Intrahepatic Portosystemic Shunt Creation

Abstract

Real-time ultrasound-guided targeting of the portal venous system during TIPS creation results in a significantly lower radiation exposure and reduced FT. Further reduction in radiation exposure can be achieved through the use of modern angiographic units with FPDS.

Use of transabdominal ultrasound-guided transjugular portal vein puncture on radiation dose in transjugular intrahepatic portosystemic shunt formation

“…Notably the mean DAP of the US-guidance with flat panel system (i.e., similar to our system) was 129 Gy·cm 2 , three times higher than our series. Similarly, more fluoroscopy time was required (mean over 19 min); however, this maybe due to the difference between the flat panel system used, whereby we used a lower pulse rate of 3 frames per second compared with 7.5 frames per second in the series reported by Miraglia et al (17).…”

“…Other groups have described use of the ultrasound-guided portosystemic shunts: Livingstone outlined 19 cases (mainly caval-PV shunts) where the mean DAP was 63.9 Gy·cm 2 and mean fluoroscopy time 19 min 12 s (16). More recently, Miraglia et al (17) compared radiation dose from ultrasound-guided TIPS using flat panel detectors and image intensifier systems to fluoroscopic needle guidance for the PV puncture: DAP and fluoroscopy times were lower for ultrasound-guidance versus fluoroscopy. Notably the mean DAP of the US-guidance with flat panel system (i.e., similar to our system) was 129 Gy·cm 2 , three times higher than our series.…”

“…However, the increasing prevalence of obesity and nonalcoholic fatty liver disease may impact the utility of ultrasound. It is pertinent to note that we used the Rösch-Uchida set whereas the only large cohort of TIPS performed with real-time ultrasound guidance for PV targeting was performed with the Colapinto needle (17). Therefore, real-time ultrasound guidance is feasible with both systems currently available for TIPS creation.…”

“…Other methods include arterial portography, the "gun-sight" technique (10), hybrid magnetic resonance imaging (MRI) and fluoroscopy (11), cone beam computed tomography (CT) (12), and intravascular ultrasound (13). Transabdominal ultrasound guidance offers a noninvasive method, which has infrequently been reported in the literature (14)(15)(16)(17), and despite its advantages is not widely used in Europe (4).…”

Diagnostic hepatic haemodynamic techniques: safety and radiation exposure

“…Miraglia et al . recently described radioexposure for transjugular porto‐systemic shunt (TIPS) creation.…”