Technical and Medium-Term Clinical Outcomes of Transjugular Intrahepatic Portosystemic Shunt with Fluoroscopy and Additional Trans-abdominal Ultrasound Guidance

Abstract

Background and Objective The aim of the study is to evaluate the technical and clinical outcomes of transjugular intrahepatic portosystemic shunt (TIPS) performed with additional transabdominal ultrasound guidance. Material and Methods Patients who underwent TIPS between January 2004 to January 2020 in our center were studied. Technical, hemodynamic, angiographic, and clinical outcome were recorded up to 1 year of follow-up. Results TIPS was attempted in 162 patients (median [range] age 37[3–69] years; 105 were males and 57 were females; Etiology: Budd-Chiari syndrome [BCS] 91, cirrhosis 65, symptomatic acute portal venous thrombosis [PVT] 3, veno-occlusive disease [VOD] 2, congenital portosystemic shunt [CPSS] 1) during the study period. Indication for TIPS was refractory ascites in 135 patients (BCS 86, cirrhosis 49) and variceal bleed in 21 patients (BCS 5, cirrhosis 16). Technical success was seen in 161 of the 162 (99.4%) patients. The tract was created from hepatic vein in 55 patients and inferior vena cava (IVC) in 106 patients. Complications within 1 week post TIPS were seen in 29 of the 162 (18%) patients, of whom one developed unexplained arrhythmia and hypotension and died. Of the patients with available follow-up, clinical success was noted in 120 (81%), while 14 (9%) patients had partial nonresponse and six (4%) had complete nonresponse. Eight (5%) patients died during the follow-up period. Conclusion The technical success of TIPS creation with additional transabdominal ultrasound guidance is very high with low peri-procedural complication rate. It has enabled the inclusion of a wider spectrum of cases like acute PVT and obliterated hepatic veins which were otherwise considered contraindications.

Techniques for portal vein targeting during a transjugular intrahepatic portosystemic shunt

“…A TIPS under fluoroscopic guidance with additional transabdominal ultrasound guidance is another technique that is particularly useful when patients have acute portal vein thrombosis or when the hepatic venous system is not patent. 8 While the technical success rate utilizing this technique is high and the complication rate is low, the use of this technique is limited in obese patients and when ascites is present. 8 …”

“… 8 While the technical success rate utilizing this technique is high and the complication rate is low, the use of this technique is limited in obese patients and when ascites is present. 8 …”

Role of Endoscopic Ultrasound in Detection of Gallbladder Diseases

“…When evaluating the uterus, informing the patient to maintain a full bladder will aid in visualization secondary to fluid in the bladder providing an acoustic window to deeper structures. (14)…”

Imaging Approach to Portal Hypertension

“…Adding US to the fluoroscopic guidance during the creation of TIPS increases the success rate and reduces the complication and radiation dose. 55 56 A covered stent placed in the parenchymal tract increases long-term patency. A complication of TIPS is hepatic encephalopathy.…”