Contrast Enhanced Computed Tomography and Reconstruction of Hepatic Vascular System for Transjugular Intrahepatic Portal Systemic Shunt Puncture Path Planning

Overview

Journal World J Gastroenterol

Publisher Baishideng Publishing Group

Specialty Gastroenterology

Date 2015 Sep 2

PMID 26327770

Citations 7

Authors

Jian-Ping Qin

Shan-Hong Tang

Ming-De Jiang

Qian-Wen He

Hong-Bin Chen

Xin Yao

Wei-Zheng Zeng

Ming Gu

Affiliations

Soon will be listed here.

Abstract

Aim: To describe a method for the transjugular intrahepatic portal systemic shunt (TIPS) placement performed with the aid of contrast-enhanced computed tomography (CECT) and three-dimensional reconstructed vascular images (3D RVIs), and to assess its safety and effectiveness.

Methods: Four hundred and ninety patients were treated with TIPS between January 2005 and December 2012. All patients underwent liver CECT and reconstruction of 3D RVIs of the right hepatic vein to portal vein (PV) prior to the operation. The 3D RVIs were carefully reviewed to plan the puncture path from the start to target points for needle pass through the PV in the TIPS procedure.

Results: The improved TIPS procedure was successful in 483 (98.6%) of the 490 patients. The number of punctures attempted was one in 294 (60%) patients, 2 to 3 in 147 (30%) patients, 4 to 6 in 25 (5.1%) patients and more than 6 in 17 (3.5%) patients. Seven patients failed. Of the 490 patients, 12 had punctures into the artery, 15 into the bile duct, eight into the gallbladder, and 18 through the liver capsule. Analysis of the portograms from the 483 successful cases indicated that the puncture points were all located distally to the PV bifurcation on anteroposterior images, while the points were located proximally to the bifurcation in the three cases with intraabdominal bleeding. The complications included three cases of bleeding, of whom one died and two needed surgery.

Conclusion: Use of CECT and 3D RVIs to plan the puncture path for TIPS procedure is safe, simple and effective for clinical use.

Citing Articles

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References

Rose S, Pretorius D, Nelson T, Kinney T, Huynh T, Roberts A . Adjunctive 3D US for achieving portal vein access during transjugular intrahepatic portosystemic shunt procedures. J Vasc Interv Radiol. 2000; 11(6):10 p following 805. DOI: 10.1016/s1051-0443(07)61646-7. View

Kim J, Yun W, Kim J, Joo Y, Park J . Extrahepatic portal vein tear with intraperitoneal hemorrhage during TIPS. Cardiovasc Intervent Radiol. 2002; 24(6):436-7. DOI: 10.1007/s00270-001-0051-5. View

Krajina A, Lojik M, Chovanec V, Raupach J, Hulek P . Wedged hepatic venography for targeting the portal vein during TIPS: comparison of carbon dioxide and iodinated contrast agents. Cardiovasc Intervent Radiol. 2002; 25(3):171-5. DOI: 10.1007/s00270-001-0096-5. View

Petersen B . Intravascular ultrasound-guided direct intrahepatic portacaval shunt: description of technique and technical refinements. J Vasc Interv Radiol. 2003; 14(1):21-32. View

Yang L, Bettmann M . Identification of the portal vein: wedge hepatic venography with CO2 or iodinated contrast medium. Acad Radiol. 2003; 6(2):89-93. DOI: 10.1016/S1076-6332(99)80487-5. View

Kwok P, Ng W, Lam C, Tsui P, Faruqi A . Anatomy of the portal vein bifurcation: implication for transjugular intrahepatic portal systemic shunts. Cardiovasc Intervent Radiol. 2003; 26(3):261-4. DOI: 10.1007/s00270-003-2679-9. View

Petersen B, Binkert C . Intravascular ultrasound-guided direct intrahepatic portacaval shunt: midterm follow-up. J Vasc Interv Radiol. 2004; 15(9):927-38. DOI: 10.1097/01.RVI.0000133703.35041.42. View

Rosch J, Uchida B, Putnam J, Buschman R, Law R, Hershey A . Experimental intrahepatic portacaval anastomosis: use of expandable Gianturco stents. Radiology. 1987; 162(2):481-5. DOI: 10.1148/radiology.162.2.3797662. View

Altin R, Flicker S, Naidech H . Pseudoaneurysm and arteriovenous fistula after femoral artery catheterization: association with low femoral punctures. AJR Am J Roentgenol. 1989; 152(3):629-31. DOI: 10.2214/ajr.152.3.629. View

10.

Rossle M, Richter G, Noldge G, Palmaz J, Wenz W, Gerok W . New non-operative treatment for variceal haemorrhage. Lancet. 1989; 2(8655):153. DOI: 10.1016/s0140-6736(89)90201-8. View

11.

Matsui O, Kadoya M, Yoshikawa J, Gabata T, Miyayama S, Takashima T . A new coaxial needle system, hepatic artery targeting wire, and biplane fluoroscopy to increase safety and efficacy of TIPS. Cardiovasc Intervent Radiol. 1994; 17(6):343-6. DOI: 10.1007/BF00203956. View

12.

Warner D, Owens C, Hibbeln J, Ray Jr C . Indirect localization of the portal vein during a transjugular intrahepatic portosystemic shunt procedure: placement of a radiopaque marker in the hepatic artery. J Vasc Interv Radiol. 1995; 6(1):87-9; discussion 89-90. DOI: 10.1016/s1051-0443(95)71065-x. View

13.

Roeren T, Richter G, Limberg B, Jacoby I, Kauffmann G . [Ultrasound guided puncture of the portal vein in transjugular intrahepatic portasystemic stent shunt (TIPSS)]. Radiologe. 1996; 36(9):677-82. DOI: 10.1007/s001170050127. View

14.

Kee S, Ganguly A, Daniel B, Wen Z, Butts K, Shimikawa A . MR-guided transjugular intrahepatic portosystemic shunt creation with use of a hybrid radiography/MR system. J Vasc Interv Radiol. 2005; 16(2 Pt 1):227-34. DOI: 10.1097/01.RVI.0000143766.08029.6E. View

15.

Boyer T, Haskal Z . American Association for the Study of Liver Diseases Practice Guidelines: the role of transjugular intrahepatic portosystemic shunt creation in the management of portal hypertension. J Vasc Interv Radiol. 2005; 16(5):615-29. DOI: 10.1097/01.RVI.0000157297.91510.21. View

16.

Raza S, Walser E, Hernandez A, Chen K, Marroquin S . Transhepatic puncture of portal and hepatic veins for TIPS using a single-needle pass under sonographic guidance. AJR Am J Roentgenol. 2006; 187(1):W87-91. DOI: 10.2214/AJR.05.1342. View

17.

Maleux G, Nevens F, Heye S, Verslype C, Marchal G . The use of carbon dioxide wedged hepatic venography to identify the portal vein: comparison with direct catheter portography with iodinated contrast medium and analysis of predictive factors influencing level of opacification. J Vasc Interv Radiol. 2006; 17(11 Pt 1):1771-9. DOI: 10.1097/01.RVI.0000242185.26944.60. View

18.

Liu J, Fan D . Hepatitis B in China. Lancet. 2007; 369(9573):1582-3. DOI: 10.1016/S0140-6736(07)60723-5. View

19.

Boyer T, Haskal Z . The Role of Transjugular Intrahepatic Portosystemic Shunt (TIPS) in the Management of Portal Hypertension: update 2009. Hepatology. 2009; 51(1):306. DOI: 10.1002/hep.23383. View

20.

Castillo-Sang M, Tsang A, Almaroof B, Cireddu J, Sferra J, Zelenock G . Femoral artery complications after cardiac catheterization: a study of patient profile. Ann Vasc Surg. 2009; 24(3):328-35. DOI: 10.1016/j.avsg.2009.06.025. View