title: Transjugular intrahepatic portosystemic shunt creation using intravascular ultrasound guidance.
abstract: OBJECTIVE
  To describe the use of intravascular ultrasound (US) guidance for creation of transjugular intrahepatic portosystemic shunts (TIPSs) in humans.
  
  
  METHODS
  The initial 25 cases of intravascular US-guided TIPS were retrospectively compared versus the last 75 conventional TIPS cases during the same time period at the same institution in terms of the number of needle passes required to establish portal vein (PV) access, fluoroscopy time, and needle pass-related complications.
  
  
  RESULTS
  Intravascular US-guided TIPS creation was successful in all cases, and there was no statistically significant difference in number of needle passes, fluoroscopy time, or needle pass-related complications between TIPS techniques. Intravascular US-guided TIPS creation was successful in cases in which conventional TIPS creation had failed as a result of PV thrombosis or distorted anatomy. Intravascular US guidance for TIPS creation was additionally useful in a patient with Budd-Chiari syndrome and in a patient with intrahepatic tumors.
  
  
  CONCLUSIONS
  Intravascular US is a safe and reproducible means of real-time image guidance for TIPS creation, equivalent in efficacy to conventional fluoroscopic guidance. Real-time sonographic guidance with intravascular US may prove advantageous for cases in which there is PV thrombus, distorted anatomy, Budd-Chiari syndrome, or hepatic tumors.
authors.affiliation: Dotter Interventional Institute, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., L-605, Portland, OR 97239, USA. farsad@ohsu.edu
authors.forename: Khashayar
authors.initials: K
authors.lastname: Farsad
authors.forename: Cristina
authors.initials: C
authors.lastname: Fuss
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Kolbeck
authors.forename: Robert E
authors.initials: RE
authors.lastname: Barton
authors.forename: Paul C
authors.initials: PC
authors.lastname: Lakin
authors.forename: Frederick S
authors.initials: FS
authors.lastname: Keller
authors.forename: John A
authors.initials: JA
authors.lastname: Kaufman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*; D055815:Young Adult