Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, People's Republic of China.
Department of Interventional Radiology, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, People's Republic of China.
Eur Radiol. 2018 Aug;28(8):3215-3220. doi: 10.1007/s00330-018-5316-3. Epub 2018 Feb 19.
The blind portal vein puncture remains the most challenging step during transjugular intrahepatic portosystemic shunt (TIPS) creation. We performed a prospective randomised clinical trial to compare three-dimensional (3D) roadmap with CO wedged hepatic vein portography for portal vein puncture guidance.
Between March 2017 and May 2017, 30 patients were enrolled and randomly allocated to the study group (3D roadmap) or the control group (CO wedged hepatic vein portography).
Technical success of TIPS procedures was achieved in all 30 patients. The mean number of needle passes was significantly lower in the study group (2.0 ± 1.0) compared to the control group (3.7 ± 2.5; p = 0.021). A total of six (40%) patients in the study group and three (20%) in the control group required only one puncture for the establishment of TIPS. There were no significant differences in total fluoroscopy time (p = 0.905), total procedure time (p = 0.199) and dose-area product (p = 0.870) between the two groups.
3D roadmap is a safe and technically feasible means for portal vein puncture guidance during TIPS creation, equivalent in efficacy to CO wedged hepatic vein portography. This technique could reduce the number of needle passes, thereby simplifying the TIPS procedure.
• 3D roadmap can be used to guide portal vein puncture. • Compared with CO venography, 3D roadmap reduced the number of needle passes. • 3D roadmap has a potential to simplify the TIPS procedure.
在经颈静脉肝内门体分流术（TIPS）创建过程中，盲目门静脉穿刺仍然是最具挑战性的步骤。我们进行了一项前瞻性随机临床试验，比较了三维（3D）路标与 CO 楔形肝静脉门静脉造影在门静脉穿刺引导中的作用。
2017 年 3 月至 2017 年 5 月，共纳入 30 例患者，并随机分配至研究组（3D 路标）或对照组（CO 楔形肝静脉门静脉造影）。
所有 30 例患者的 TIPS 手术均获得技术成功。研究组的平均穿刺次数明显低于对照组（2.0±1.0 次比 3.7±2.5 次；p=0.021）。研究组共有 6 例（40%）患者和对照组 3 例（20%）患者仅需一次穿刺即可建立 TIPS。两组之间的总透视时间（p=0.905）、总手术时间（p=0.199）和剂量面积乘积（p=0.870）均无显著差异。
3D 路标是一种安全且可行的 TIPS 穿刺引导技术，与 CO 楔形肝静脉门静脉造影相比，其效果相当。该技术可减少穿刺次数，从而简化 TIPS 手术。
3D 路标可用于引导门静脉穿刺。
与 CO 血管造影相比，3D 路标减少了穿刺次数。
3D 路标具有简化 TIPS 手术的潜力。
