Contrast enhanced computed tomography and reconstruction of hepatic vascular system for transjugular intrahepatic portal systemic shunt puncture path planning.
OBJECTIVE
To describe a method for the transjugular intrahepatic portal systemic shunt (TIPS) placement performed with the aid of contrast-enhanced computed tomography (CECT) and three-dimensional reconstructed vascular images (3D RVIs), and to assess its safety and effectiveness.


METHODS
Four hundred and ninety patients were treated with TIPS between January 2005 and December 2012. All patients underwent liver CECT and reconstruction of 3D RVIs of the right hepatic vein to portal vein (PV) prior to the operation. The 3D RVIs were carefully reviewed to plan the puncture path from the start to target points for needle pass through the PV in the TIPS procedure.


RESULTS
The improved TIPS procedure was successful in 483 (98.6%) of the 490 patients. The number of punctures attempted was one in 294 (60%) patients, 2 to 3 in 147 (30%) patients, 4 to 6 in 25 (5.1%) patients and more than 6 in 17 (3.5%) patients. Seven patients failed. Of the 490 patients, 12 had punctures into the artery, 15 into the bile duct, eight into the gallbladder, and 18 through the liver capsule. Analysis of the portograms from the 483 successful cases indicated that the puncture points were all located distally to the PV bifurcation on anteroposterior images, while the points were located proximally to the bifurcation in the three cases with intraabdominal bleeding. The complications included three cases of bleeding, of whom one died and two needed surgery.


CONCLUSIONS
Use of CECT and 3D RVIs to plan the puncture path for TIPS procedure is safe, simple and effective for clinical use.
Jian-Ping Qin, Shan-Hong Tang, Ming-De Jiang, Hong-Bin Chen, Xin Yao, Wei-Zheng Zeng, Department of Digestion, General Hospital of Chengdu Military Command, Chengdu 610083, Sichuan Province, China.
Jian-Ping
JP
Qin
Jian-Ping Qin, Shan-Hong Tang, Ming-De Jiang, Hong-Bin Chen, Xin Yao, Wei-Zheng Zeng, Department of Digestion, General Hospital of Chengdu Military Command, Chengdu 610083, Sichuan Province, China.
Shan-Hong
SH
Tang
Jian-Ping Qin, Shan-Hong Tang, Ming-De Jiang, Hong-Bin Chen, Xin Yao, Wei-Zheng Zeng, Department of Digestion, General Hospital of Chengdu Military Command, Chengdu 610083, Sichuan Province, China.
Ming-De
MD
Jiang
Jian-Ping Qin, Shan-Hong Tang, Ming-De Jiang, Hong-Bin Chen, Xin Yao, Wei-Zheng Zeng, Department of Digestion, General Hospital of Chengdu Military Command, Chengdu 610083, Sichuan Province, China.
Qian-Wen
QW
He
Jian-Ping Qin, Shan-Hong Tang, Ming-De Jiang, Hong-Bin Chen, Xin Yao, Wei-Zheng Zeng, Department of Digestion, General Hospital of Chengdu Military Command, Chengdu 610083, Sichuan Province, China.
Hong-Bin
HB
Chen
Jian-Ping Qin, Shan-Hong Tang, Ming-De Jiang, Hong-Bin Chen, Xin Yao, Wei-Zheng Zeng, Department of Digestion, General Hospital of Chengdu Military Command, Chengdu 610083, Sichuan Province, China.
Xin
X
Yao
Jian-Ping Qin, Shan-Hong Tang, Ming-De Jiang, Hong-Bin Chen, Xin Yao, Wei-Zheng Zeng, Department of Digestion, General Hospital of Chengdu Military Command, Chengdu 610083, Sichuan Province, China.
Wei-Zheng
WZ
Zeng
Jian-Ping Qin, Shan-Hong Tang, Ming-De Jiang, Hong-Bin Chen, Xin Yao, Wei-Zheng Zeng, Department of Digestion, General Hospital of Chengdu Military Command, Chengdu 610083, Sichuan Province, China.
Ming
M
Gu
D000328:Adult; D003287:Contrast Media / Q000008:administration & dosage*; D005260:Female; D006503:Hepatic Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000601:surgery*; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects / Q000379:methods*; D011172:Portography / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D011237:Predictive Value of Tests; D011677:Punctures; D011857:Radiographic Image Interpretation, Computer-Assisted; D015641:Radiography, Interventional / Q000379:methods*; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D003287:Contrast Media
3D vascular reconstruction; Contrast-enhanced computed tomography; Interventional radiology; Transjugular intrahepatic portal systemic shunt