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Three-dimensional C-arm CT-guided transjugular intrahepatic portosystemic shunt placement: Feasibility, technical success and procedural time

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Abstract

Objectives

Establishment of transjugular intrahepatic portosystemic shunts (TIPS) constitutes a standard procedure in patients suffering from portal hypertension. The most difficult step in TIPS placement is blind puncture of the portal vein. This study aimed to evaluate three-dimensional mapping of portal vein branches and targeted puncture of the portal vein.

Methods

Twelve consecutive patients suffering from refractory ascites by liver cirrhosis were included in this retrospective study to evaluate feasibility, technical success and procedural time of C-arm CT-targeted puncture of the portal vein. As a control, 22 patients receiving TIPS placement with fluoroscopy-guided blind puncture were included to compare procedural time.

Results

Technical success could be obtained in 100 % of the study group (targeted puncture) and in 95.5 % of the control group (blind puncture). Appropriate, three-dimensional C-arm CT-guided mapping of the portal vein branches could be achieved in all patients. The median number of punctures in the C-arm CT-guided study group was 2 ± 1.3 punctures. Procedural time was significantly lower in the study group (14.8 ± 8.2 min) compared to the control group (32.6 ± 22.7 min) (p = 0.02).

Conclusions

C-arm CT-guided portal vein mapping is technically feasible and a promising tool for TIPS placement resulting in a significant reduction of procedural time.

Key Points

• C-arm CT-mapping of the portal vein for 3D TIPS guidance is feasible.

• Targeted punctures of the portal vein by C-arm CT reduce procedural time.

• A decreased number of punctures could improve patient safety.

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Acknowledgments

The scientific guarantor of this publication is PD Dr. Dominik Ketelsen, MD. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was not required due to retrospective study design. Written informed consent was obtained from all subjects (patients) in this study. Methodology: retrospective, observational study, performed at one institution.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany

    Dominik Ketelsen, Gerd Groezinger, Michael Maurer, Ulrich Grosse, Marius Horger, Konstantin Nikolaou & Roland Syha

  2. Internal Medicine I, Department of Gastroenterology, Hepatology and Infectious disease, University of Tuebingen, Otfried-Mueller-Str. 10, 72076, Tuebingen, Germany

    Ulrich M. Lauer

Authors
  1. Dominik Ketelsen
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  2. Gerd Groezinger
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  3. Michael Maurer
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  4. Ulrich M. Lauer
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  5. Ulrich Grosse
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  6. Marius Horger
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  7. Konstantin Nikolaou
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  8. Roland Syha
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Correspondence to Dominik Ketelsen.

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Ketelsen, D., Groezinger, G., Maurer, M. et al. Three-dimensional C-arm CT-guided transjugular intrahepatic portosystemic shunt placement: Feasibility, technical success and procedural time. Eur Radiol 26, 4277–4283 (2016). https://doi.org/10.1007/s00330-016-4340-4

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  • DOI: https://doi.org/10.1007/s00330-016-4340-4

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