Single Puncture TIPS—A 3D Fusion Image-Guided Transjugular Intrahepatic Portosystemic Shunt (TIPS): An Experimental Study
Background: The use of a transjugular intrahepatic portosystemic shunt (TIPS) has been established as an effective treatment for portal hypertension. Despite the rapid development of this use, serious peri-procedural complications have been reported in over 10% of cases. This has largely been attrib...
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MDPI AG
2022-05-01
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| Online Access: | https://www.mdpi.com/2076-3417/12/10/5267 |
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| author | Edward Wolfgang Lee Puja Shahrouki Sammy Saab Fady Kaldas Navid Eghbalieh Justin McWilliams Peng-Xu Ding Stephen T. Kee |
| author_facet | Edward Wolfgang Lee Puja Shahrouki Sammy Saab Fady Kaldas Navid Eghbalieh Justin McWilliams Peng-Xu Ding Stephen T. Kee |
| author_sort | Edward Wolfgang Lee |
| collection | DOAJ |
| description | Background: The use of a transjugular intrahepatic portosystemic shunt (TIPS) has been established as an effective treatment for portal hypertension. Despite the rapid development of this use, serious peri-procedural complications have been reported in over 10% of cases. This has largely been attributed to the access to the portal vein, also referred to as a “blind puncture”, which often requires multiple attempts. The aim of this study was to demonstrate the safety, reproducibility and accuracy of the use of real-time 3D fusion image-guided (3DFIG) single puncture TIPS to minimize the complications that are related to the “blind puncture” of TIPS procedures. Methods: A 3DFIG TIPS approach was utilized on 22 pigs by combining pre-procedural cross-sectional imaging (CT, MR or CBCT) with intra-procedural cone beam CT or angiogram imaging, which allowed for the improved 3D visual spatial orientation of the portal vein and real-time tracking of the needle in 3D. Results: Thirty-five portosystemic shunts were successfully deployed in all 22 subjects without any peri-procedural complications. Overall, 91% (32/35) of the procedures were carried out using a single puncture. In addition, the mean fluoroscopy time in our study was more than 12 times lower than the proposed reference level that has previously been proposed for TIPS procedures. Conclusion: Multi-modality real-time 3DFIG TIPS can be performed safely using a single puncture, without complications, and can potentially be used in both emergency and non-emergency clinical situations. |
| first_indexed | 2024-03-10T03:22:25Z |
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| id | doaj.art-5f8280da478143ca9a23a1d4eac8d7ad |
| institution | Directory Open Access Journal |
| issn | 2076-3417 |
| language | English |
| last_indexed | 2024-03-10T03:22:25Z |
| publishDate | 2022-05-01 |
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| series | Applied Sciences |
| spelling | doaj.art-5f8280da478143ca9a23a1d4eac8d7ad2023-11-23T10:00:09ZengMDPI AGApplied Sciences2076-34172022-05-011210526710.3390/app12105267Single Puncture TIPS—A 3D Fusion Image-Guided Transjugular Intrahepatic Portosystemic Shunt (TIPS): An Experimental StudyEdward Wolfgang Lee0Puja Shahrouki1Sammy Saab2Fady Kaldas3Navid Eghbalieh4Justin McWilliams5Peng-Xu Ding6Stephen T. Kee7Division of Interventional Radiology, Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USADivision of Interventional Radiology, Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USADumont-UCLA Transplant Center, University of California, Los Angeles, CA 90095, USADivision of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA 90095, USADivision of Interventional Radiology, Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USADivision of Interventional Radiology, Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USADivision of Interventional Radiology, Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USADivision of Interventional Radiology, Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USABackground: The use of a transjugular intrahepatic portosystemic shunt (TIPS) has been established as an effective treatment for portal hypertension. Despite the rapid development of this use, serious peri-procedural complications have been reported in over 10% of cases. This has largely been attributed to the access to the portal vein, also referred to as a “blind puncture”, which often requires multiple attempts. The aim of this study was to demonstrate the safety, reproducibility and accuracy of the use of real-time 3D fusion image-guided (3DFIG) single puncture TIPS to minimize the complications that are related to the “blind puncture” of TIPS procedures. Methods: A 3DFIG TIPS approach was utilized on 22 pigs by combining pre-procedural cross-sectional imaging (CT, MR or CBCT) with intra-procedural cone beam CT or angiogram imaging, which allowed for the improved 3D visual spatial orientation of the portal vein and real-time tracking of the needle in 3D. Results: Thirty-five portosystemic shunts were successfully deployed in all 22 subjects without any peri-procedural complications. Overall, 91% (32/35) of the procedures were carried out using a single puncture. In addition, the mean fluoroscopy time in our study was more than 12 times lower than the proposed reference level that has previously been proposed for TIPS procedures. Conclusion: Multi-modality real-time 3DFIG TIPS can be performed safely using a single puncture, without complications, and can potentially be used in both emergency and non-emergency clinical situations.https://www.mdpi.com/2076-3417/12/10/5267transjugular intrahepatic portosystemic shunt (TIPS)direct intrahepatic portosystemic shunt (DIPS)3D fusion imagingportal vein puncturecomplications |
| spellingShingle | Edward Wolfgang Lee Puja Shahrouki Sammy Saab Fady Kaldas Navid Eghbalieh Justin McWilliams Peng-Xu Ding Stephen T. Kee Single Puncture TIPS—A 3D Fusion Image-Guided Transjugular Intrahepatic Portosystemic Shunt (TIPS): An Experimental Study Applied Sciences transjugular intrahepatic portosystemic shunt (TIPS) direct intrahepatic portosystemic shunt (DIPS) 3D fusion imaging portal vein puncture complications |
| title | Single Puncture TIPS—A 3D Fusion Image-Guided Transjugular Intrahepatic Portosystemic Shunt (TIPS): An Experimental Study |
| title_full | Single Puncture TIPS—A 3D Fusion Image-Guided Transjugular Intrahepatic Portosystemic Shunt (TIPS): An Experimental Study |
| title_fullStr | Single Puncture TIPS—A 3D Fusion Image-Guided Transjugular Intrahepatic Portosystemic Shunt (TIPS): An Experimental Study |
| title_full_unstemmed | Single Puncture TIPS—A 3D Fusion Image-Guided Transjugular Intrahepatic Portosystemic Shunt (TIPS): An Experimental Study |
| title_short | Single Puncture TIPS—A 3D Fusion Image-Guided Transjugular Intrahepatic Portosystemic Shunt (TIPS): An Experimental Study |
| title_sort | single puncture tips a 3d fusion image guided transjugular intrahepatic portosystemic shunt tips an experimental study |
| topic | transjugular intrahepatic portosystemic shunt (TIPS) direct intrahepatic portosystemic shunt (DIPS) 3D fusion imaging portal vein puncture complications |
| url | https://www.mdpi.com/2076-3417/12/10/5267 |
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