[The role of magnetic resonance angiography prior to the transjugular placement of a portosystemic stent shunt (TIPS)].
The authors employed magnetic resonance angiography (MRA) to guide catheter placement for transjugular intrahepatic portosystemic stent shunt (TIPS) procedures in 14 of 24 patients, and compared the results to the 10 patients who did not have prior planning based on MRA. Two-dimensional time-of-flight venography was performed during breath holding, and projection venograms were formatted in sagittal, coronal and axial planes. MRA defined venous anatomy sufficiently well to shorten the procedure and helped to minimize invasiveness. With MRA guidance, intrahepatic needle punctures were significantly fewer (without MRA guidance: mean 12.1; with MRA guidance: mean 3.5, p < 0.001) and associated complications were absent (without MRA guidance: failed placement, N = 1; bleeding requiring blood transfusions, N = 2; death complicating intraperitoneal haemorrhage with haemobilia, N = 1, and hepatic capsular perforation, N = 1). The average time for the procedure was 2.8 hours without MRA guidance and 1.8 hours with MRA guidance (p < 0.0005). The authors conclude that MR angiography is a useful technique to define portal and hepatic venous anatomy prior to TIPS, and planning based on MRA may decrease the difficulty and length of the procedure.
Müller
M F
MF
Department of Radiology, Beth Israel Hospital, Boston.
Siewert
B
B
Kim
D
D
Edelman
R R
RR
Stokes
K R
KR
Finn
J P
JP
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D011170:Portasystemic Shunt, Surgical / Q000379:methods*; D015607:Stents
Rolle der Magnetresonanzangiographie vor transjugulärer Einlage eines portosystemischen Stent-Shunts (TIPS).