title: Intravascular Ultrasound in the Creation of Transhepatic Portosystemic Shunts Reduces Needle Passes, Radiation Dose, and Procedure Time: A Retrospective Study of a Single-Institution Experience.
abstract: OBJECTIVE
  To assess whether intravascular ultrasound (US) guidance impacts number of needle passes, contrast usage, radiation dose, and procedure time during creation of transjugular intrahepatic portosystemic shunts (TIPS).
  
  
  METHODS
  Intravascular US-guided creation of TIPS in 40 patients was retrospectively compared with conventional TIPS in 49 patients between February 2010 and November 2015 at a single tertiary care institution. Patient sex and age, etiology of liver disease (hepatitis C virus, alcohol abuse, nonalcoholic steatohepatitis), severity of liver disease (mean Model for End-Stage Liver Disease score), and indications for TIPS (variceal bleeding, refractory ascites, refractory hydrothorax) in conventional and intravascular US-guided cases were recorded.
  
  
  RESULTS
  The two groups were well matched by sex, age, etiology of liver disease, Child-Pugh class, Model for End-Stage Liver Disease scores, and indication for TIPS (P range = .19-.94). Fewer intrahepatic needle passes were required in intravascular US-guided TIPS creation compared with conventional TIPS (2 passes vs 6 passes, P < .01). Less iodinated contrast material was used in intravascular US cases (57 mL vs 140 mL, P < .01). Radiation exposure, as measured by cumulative dose, dose area product, and fluoroscopy time, was reduced with intravascular US (174 mGy vs 981 mGy, P < .01; 3,793 μGy * m(2) vs 21,414 μGy * m(2), P < .01; 19 min vs 34 min, P < .01). Procedure time was shortened with intravascular US (86 min vs 125 min, P < .01).
  
  
  CONCLUSIONS
  Intravascular US guidance resulted in fewer intrahepatic needle passes, decreased contrast medium usage, decreased radiation dosage, and shortened procedure time in TIPS creation.
authors.affiliation: Departments of Radiology, University of California San Diego Medical Center, 200 West Arbor Drive #8756, San Diego, CA 92103; Department of Radiology, University of California Los Angeles Medical Center, Los Angeles, California.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Kao
authors.affiliation: Department of Radiology, University of California Los Angeles Medical Center, Los Angeles, California.
authors.forename: Maud M
authors.initials: MM
authors.lastname: Morshedi
authors.affiliation: Departments of Radiology, University of California San Diego Medical Center, 200 West Arbor Drive #8756, San Diego, CA 92103.
authors.forename: Kazim H
authors.initials: KH
authors.lastname: Narsinh
authors.affiliation: Departments of Radiology, University of California San Diego Medical Center, 200 West Arbor Drive #8756, San Diego, CA 92103.
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Kinney
authors.affiliation: Departments of Radiology, University of California San Diego Medical Center, 200 West Arbor Drive #8756, San Diego, CA 92103.
authors.forename: Jeet
authors.initials: J
authors.lastname: Minocha
authors.affiliation: Departments of Radiology, University of California San Diego Medical Center, 200 West Arbor Drive #8756, San Diego, CA 92103.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Picel
authors.affiliation: Departments of Radiology, University of California San Diego Medical Center, 200 West Arbor Drive #8756, San Diego, CA 92103.
authors.forename: Isabel
authors.initials: I
authors.lastname: Newton
authors.affiliation: Departments of Radiology, University of California San Diego Medical Center, 200 West Arbor Drive #8756, San Diego, CA 92103.
authors.forename: Steven C
authors.initials: SC
authors.lastname: Rose
authors.affiliation: Departments of Radiology, University of California San Diego Medical Center, 200 West Arbor Drive #8756, San Diego, CA 92103.
authors.forename: Anne C
authors.initials: AC
authors.lastname: Roberts
authors.affiliation: Gastroenterology/Hepatology, University of California San Diego Medical Center, 200 West Arbor Drive #8756, San Diego, CA 92103.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kuo
authors.affiliation: Departments of Radiology, University of California San Diego Medical Center, 200 West Arbor Drive #8756, San Diego, CA 92103. Electronic address: haryafar@ucsd.edu.
authors.forename: Hamed
authors.initials: H
authors.lastname: Aryafar
mesh_terms: D000328:Adult; D000368:Aged; D002140:California; D003287:Contrast Media / Q000008:administration & dosage; D005471:Fluoroscopy; D006801:Humans; D006975:Hypertension, Portal / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis; D008875:Middle Aged; D009339:Needles; D061646:Operative Time; D017082:Portal Pressure; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects / Q000295:instrumentation; D011677:Punctures; D011829:Radiation Dosage; D000069079:Radiation Exposure; D015641:Radiography, Interventional / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000009:adverse effects
chemical_list: D003287:Contrast Media