Feasibility of electromagnetically guided transjugular intrahepatic portosystemic shunt procedure.
OBJECTIVE
To develop an electromagnetic navigation technology for transjugular intrahepatic portosystemic shunt (TIPS) creation and translate it from phantom to an in-vivo large animal setting.


METHODS
A custom-designed device for TIPS creation consisting of a stylet within a 5 French catheter as well as a software prototype were developed that allow real-time tip tracking of both stylet and catheter using an electromagnetic tracking system. Feasibility of navigated TIPSS creation was tested in a phantom by two interventional radiologists (A/B) followed by in-vivo testing evaluation in eight domestic pigs. Procedure duration and number of attempts needed for puncture of the portal vein were recorded.


RESULTS
In the phantom setting, intervention time to gain access to the portal vein (PV) was 144 ± 67 s (A) and 122 ± 51 s (B), respectively. In the in-vivo trials, TIPS could be successfully completed in five out of eight animals. Mean time for the complete TIPS was 245 ± 205 minutes with a notable learning curve towards the last animal.


CONCLUSIONS
TIPS creation with the use of electromagnetic tracking technology proved to be feasible in-vitro as well as in-vivo. The system may be useful to facilitate challenging TIPSS procedures.
a Diagnostic and Interventional Radiology , RWTH Aachen University Hospital , Aachen , Germany.
Peter
P
Isfort
a Diagnostic and Interventional Radiology , RWTH Aachen University Hospital , Aachen , Germany.|b Surgical Planning Laboratory , Brigham and Women's Hospital , Boston , MA , USA.|c Diagnostic and Interventional Radiology , Charité Universitätsmedizin Berlin , Berlin , Germany.
Tobias
T
Penzkofer
a Diagnostic and Interventional Radiology , RWTH Aachen University Hospital , Aachen , Germany.
Christoph
C
Wilkmann
a Diagnostic and Interventional Radiology , RWTH Aachen University Hospital , Aachen , Germany.
Hong-Sik
HS
Na
a Diagnostic and Interventional Radiology , RWTH Aachen University Hospital , Aachen , Germany.
Christian
C
Kotzlowski
d Department of Radiology , Keio University , Tokyo , Japan.|e Applied Medical Engineering , RWTH Aachen University Hospital , Aachen , Germany.
Nobutake
N
Ito
a Diagnostic and Interventional Radiology , RWTH Aachen University Hospital , Aachen , Germany.
Joachim Georg
JG
Pfeffer
h Medical Engineering , RWTH Aachen University , Aachen , Germany.
Stefan
S
Bisplinghoff
f Vygon GmbH & Co. KG , Aachen , Germany.
Sabine
S
Osterhues
g SurgiTAIX AG , Herzogenrath , Germany.
Andreas
A
Besting
e Applied Medical Engineering , RWTH Aachen University Hospital , Aachen , Germany.
Jorge
J
Gooding
e Applied Medical Engineering , RWTH Aachen University Hospital , Aachen , Germany.
Thomas
T
Schmitz-Rode
a Diagnostic and Interventional Radiology , RWTH Aachen University Hospital , Aachen , Germany.
Christiane
C
Kuhl
i Department of Diagnostic and Interventional Radiology , Philips University Hospital , Marburg , Germany.
Andreas Horst
AH
Mahnken
a Diagnostic and Interventional Radiology , RWTH Aachen University Hospital , Aachen , Germany.
Philipp
P
Bruners
D000818:Animals; D055590:Electromagnetic Phenomena; D004867:Equipment Design; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation*; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000295:instrumentation*; D013552:Swine; D018084:Ultrasonography, Interventional / Q000379:methods*
Image-guided procedures; interventional radiology; vascular intervention