title: Impact of Anatomical, Procedural, and Operator Skill Factors on the Success and Duration of Fluoroscopy-Guided Transjugular Intrahepatic Portosystemic Shunt.
abstract: OBJECTIVE
  To assess the impact of anatomical, procedural, and operator skill factors on the success and duration of fluoroscopy-guided transjugular intrahepatic portoystemic shunt following standard operating procedure (SOP).
  
  
  METHODS
  During a 32-month period, 102 patients underwent transjugular intrahepatic portosystemic shunt creation (TIPS) by two interventional radiologists (IR) following our institutional SOP based on fluoroscopy guidance. Both demographic and procedural data were assessed. The duration of the intervention (D(Int)) and of the portal vein puncture (D(Punct)) was analyzed depending on the skill level of the IR as well as the anatomic or procedural factors.
  
  
  RESULTS
  In 99 of the 102 patients, successful TIPS without peri-procedural complications was performed. The mean D(Int) (IR1: 77 min; IR2: 51 min, P < 0.005) and the mean D(Punct) (IR1: 19 min; IR2: 13 min, P < 0.005) were significantly higher in TIPS performed by IR1 (with 2 years of clinical experience performing TIPS, n = 38) than by IR2 (>10 years of clinical experience performing TIPS, n = 61), (P < 0.005 both, Mann-Whitney U test). D Int showed a higher correlation with D(Punct) for IR2 (R(2) = 0.63) than for IR1 (R(2) = 0.13). There was no significant difference in the D(Punct )for both IRs with regard to the success of the wedged portography (P = 0.90), diameter of the portal vein (P = 0.60), central right portal vein length (P = 0.49), or liver function (MELD-Score before the TIPS procedure; P = 0.14).
  
  
  CONCLUSIONS
  TIPS following SOP is safe, fast, and reliable. The only significant factor for shorter D(Punct) and D(Int) was the clinical experience of the IR. Anatomic variability, successful portography, or liver function did not alter the duration or technical success of TIPS.
authors.affiliation: Department of Diagnostic and Interventional Radiology, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany, marquardt.steffen@mh-hannover.de.
authors.forename: Steffen
authors.initials: S
authors.lastname: Marquardt
authors.forename: Thomas
authors.initials: T
authors.lastname: Rodt
authors.forename: Herbert
authors.initials: H
authors.lastname: Rosenthal
authors.forename: Frank
authors.initials: F
authors.lastname: Wacker
authors.forename: Bernhard C
authors.initials: BC
authors.lastname: Meyer
mesh_terms: D000328:Adult; D000368:Aged; D002983:Clinical Competence / Q000706:statistics & numerical data*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000033:anatomy & histology* / Q000000981:diagnostic imaging*; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000706:statistics & numerical data*; D011677:Punctures; D015642:Radiology, Interventional / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult