title: Three-dimensional C-arm CT-guided transjugular intrahepatic portosystemic shunt placement: Feasibility, technical success and procedural time.
abstract: OBJECTIVE
  Establishment of transjugular intrahepatic portosystemic shunts (TIPS) constitutes a standard procedure in patients suffering from portal hypertension. The most difficult step in TIPS placement is blind puncture of the portal vein. This study aimed to evaluate three-dimensional mapping of portal vein branches and targeted puncture of the portal vein.
  
  
  METHODS
  Twelve consecutive patients suffering from refractory ascites by liver cirrhosis were included in this retrospective study to evaluate feasibility, technical success and procedural time of C-arm CT-targeted puncture of the portal vein. As a control, 22 patients receiving TIPS placement with fluoroscopy-guided blind puncture were included to compare procedural time.
  
  
  RESULTS
  Technical success could be obtained in 100 % of the study group (targeted puncture) and in 95.5 % of the control group (blind puncture). Appropriate, three-dimensional C-arm CT-guided mapping of the portal vein branches could be achieved in all patients. The median number of punctures in the C-arm CT-guided study group was 2 ± 1.3 punctures. Procedural time was significantly lower in the study group (14.8 ± 8.2 min) compared to the control group (32.6 ± 22.7 min) (p = 0.02).
  
  
  CONCLUSIONS
  C-arm CT-guided portal vein mapping is technically feasible and a promising tool for TIPS placement resulting in a significant reduction of procedural time.
  
  
  CONCLUSIONS
  • C-arm CT-mapping of the portal vein for 3D TIPS guidance is feasible. • Targeted punctures of the portal vein by C-arm CT reduce procedural time. • A decreased number of punctures could improve patient safety.
authors.affiliation: Department of Diagnostic and Interventional Radiology, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany. dominik.ketelsen@med.uni-tuebingen.de.
authors.forename: Dominik
authors.initials: D
authors.lastname: Ketelsen
authors.affiliation: Department of Diagnostic and Interventional Radiology, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany.
authors.forename: Gerd
authors.initials: G
authors.lastname: Groezinger
authors.affiliation: Department of Diagnostic and Interventional Radiology, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Maurer
authors.affiliation: Internal Medicine I, Department of Gastroenterology, Hepatology and Infectious disease, University of Tuebingen, Otfried-Mueller-Str. 10, 72076, Tuebingen, Germany.
authors.forename: Ulrich M
authors.initials: UM
authors.lastname: Lauer
authors.affiliation: Department of Diagnostic and Interventional Radiology, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Grosse
authors.affiliation: Department of Diagnostic and Interventional Radiology, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany.
authors.forename: Marius
authors.initials: M
authors.lastname: Horger
authors.affiliation: Department of Diagnostic and Interventional Radiology, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany.
authors.forename: Konstantin
authors.initials: K
authors.lastname: Nikolaou
authors.affiliation: Department of Diagnostic and Interventional Radiology, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Syha
mesh_terms: D000328:Adult; D000368:Aged; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery*; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods*; D015641:Radiography, Interventional / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome
keywords: C-arm CT; TIPS guidance; Three-dimensional portal vein mapping; Transjugular intrahepatic portosystemic shunt; Wedge portography