title: Intravascular US-Guided Portal Vein Access: Improved Procedural Metrics during TIPS Creation.
abstract: OBJECTIVE
  To evaluate transjugular intrahepatic portosystemic shunt (TIPS) outcomes and procedure metrics with the use of three different image guidance techniques for portal vein (PV) access during TIPS creation.
  
  
  METHODS
  A retrospective review of consecutive patients who underwent TIPS procedures for a range of indications during a 28-month study period identified a population of 68 patients. This was stratified by PV access techniques: fluoroscopic guidance with or without portography (n = 26), PV marker wire guidance (n = 18), or intravascular ultrasound (US) guidance (n = 24). Procedural outcomes and procedural metrics, including radiation exposure, contrast agent volume used, procedure duration, and PV access time, were analyzed.
  
  
  RESULTS
  No differences in demographic or procedural characteristics were found among the three groups. Technical success, technical success of the primary planned approach, hemodynamic success, portosystemic gradient, and procedure-related complications were not significantly different among groups. Fluoroscopy time (P = .003), air kerma (P = .01), contrast agent volume (P = .003), and total procedural time (P = .02) were reduced with intravascular US guidance compared with fluoroscopic guidance. Fluoroscopy time (P = .01) and contrast agent volume (P = .02) were reduced with intravascular US guidance compared with marker wire guidance.
  
  
  CONCLUSIONS
  Intravascular US guidance of PV access during TIPS creation not only facilitates successful TIPS creation in patients with challenging anatomy, as suggested by previous investigations, but also reduces important procedure metrics including radiation exposure, contrast agent volume, and overall procedure duration compared with fluoroscopically guided TIPS creation.
authors: Department of Radiology, Division of Interventional Radiology, University of Colorado School of Medicine, Mail Stop L954, Leprino, 12401 E. 17th Ave., Room 540, Aurora, CO 80045.. Electronic address: matthew.gipson@ucdenver.edu.
authors: Matthew G
authors: MG
authors: Gipson
authors: Department of Radiology, Division of Interventional Radiology, University of Colorado School of Medicine, Mail Stop L954, Leprino, 12401 E. 17th Ave., Room 540, Aurora, CO 80045.
authors: Mitchell T
authors: MT
authors: Smith
authors: Department of Radiology, Division of Interventional Radiology, University of Colorado School of Medicine, Mail Stop L954, Leprino, 12401 E. 17th Ave., Room 540, Aurora, CO 80045.
authors: Janette D
authors: JD
authors: Durham
authors: Department of Radiology, Division of Interventional Radiology, University of Colorado School of Medicine, Mail Stop L954, Leprino, 12401 E. 17th Ave., Room 540, Aurora, CO 80045.
authors: Anthony
authors: A
authors: Brown
authors: Department of Radiology, Division of Interventional Radiology, University of Colorado School of Medicine, Mail Stop L954, Leprino, 12401 E. 17th Ave., Room 540, Aurora, CO 80045.
authors: Thor
authors: T
authors: Johnson
authors: Department of Radiology, University of Illinois at Chicago, Chicago, Illinois.
authors: Charles E
authors: CE
authors: Ray
authors: Department of Radiology, Division of Interventional Radiology, University of Colorado School of Medicine, Mail Stop L954, Leprino, 12401 E. 17th Ave., Room 540, Aurora, CO 80045.
authors: Rajan K
authors: RK
authors: Gupta
authors: Department of Radiology, Division of Interventional Radiology, University of Colorado School of Medicine, Mail Stop L954, Leprino, 12401 E. 17th Ave., Room 540, Aurora, CO 80045.
authors: Kimi L
authors: KL
authors: Kondo
authors: Department of Radiology, Division of Interventional Radiology, University of Colorado School of Medicine, Mail Stop L954, Leprino, 12401 E. 17th Ave., Room 540, Aurora, CO 80045.
authors: Paul J
authors: PJ
authors: Rochon
authors: Department of Radiology, Division of Interventional Radiology, University of Colorado School of Medicine, Mail Stop L954, Leprino, 12401 E. 17th Ave., Room 540, Aurora, CO 80045.
authors: Robert K
authors: RK
authors: Ryu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D059925:Anatomic Landmarks; D002245:Carbon Dioxide / Q000008:administration & dosage; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D006975:Hypertension, Portal / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D017082:Portal Pressure; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects; D011172:Portography; D011829:Radiation Dosage; D000069079:Radiation Exposure; D015641:Radiography, Interventional / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000009:adverse effects; D055815:Young Adult
chemical_list: D003287:Contrast Media; D002245:Carbon Dioxide