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改良经枪形探头引导下经颈内静脉肝内门体分流术。

Modified gun-sight transjugular intrahepatic portosystemic shunt technique.

机构信息

Department of Radiology, Alfred Health, Melbourne, VIC, Australia.

Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, Singapore, Singapore.

出版信息

Br J Radiol. 2022 Dec 1;95(1140):20220556. doi: 10.1259/bjr.20220556. Epub 2022 Oct 6.

DOI:10.1259/bjr.20220556
PMID:36063126
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9733616/
Abstract

OBJECTIVES

Conventional transjugular intrahepatic portosystemic shunt (TIPS) stent insertion is an established procedure with high rates of technical success. However, alternative techniques may increase success rates in the setting of challenging anatomy or limited resources. Originally described as a salvage porto-caval approach, we present a modified gun-sight porto-hepatic TIPS technique.

METHODS

A retrospective review was performed identifying patients who underwent modified gun-sight TIPS over a 1-year period. Six procedures were identified, with snares opened in the target hepatic and portal veins, fluoroscopic percutaneous transhepatic puncture through the snares, and wire pulled through-and-through to establish a parenchymal tract. Five modified gun-sight procedures were primary, and one was salvage.

RESULTS

All modified gun-sight TIPS procedures were technically successful with a single needle pass, with patency and appropriate haemodynamic flow at 2 weeks. Advantages of the technique include fluoroscopic-guided transhepatic puncture utilising typically on-shelf low-cost equipment, without requiring a dedicated TIPS set or endovascular ultrasound. Disadvantages include liver capsular puncture.

CONCLUSIONS

The modified gun-sight TIPS technique is an alternative approach utilising typically on-shelf and low-cost equipment for a targeted fluoroscopic-guided parenchymal puncture.

ADVANCES IN KNOWLEDGE

The presented technique is an initial description of a novel alternative TIPS technique, which may be useful to consider in challenging cases.

摘要

目的

传统的经颈静脉肝内门体分流术（TIPS）支架置入术是一种成熟的技术，具有较高的技术成功率。然而，在具有挑战性的解剖结构或有限资源的情况下，替代技术可能会提高成功率。最初被描述为一种抢救性门腔静脉途径，我们提出了一种改良的枪瞄式门腔 TIPS 技术。

方法

回顾性分析了 1 年内接受改良枪瞄 TIPS 的患者。共发现 6 例患者，在靶肝静脉和门静脉中张开圈套器，在圈套器下经皮经肝穿刺，将导丝穿过并建立实质通道。5 例改良枪瞄 TIPS 术为原发性，1 例为抢救性。

结果

所有改良枪瞄 TIPS 术均一次性成功，2 周时通畅性和适当的血流动力学均良好。该技术的优点包括利用通常库存的低成本设备进行荧光镜引导下的经肝穿刺，无需专用 TIPS 套件或血管内超声。缺点包括肝包膜穿刺。

结论

改良枪瞄 TIPS 技术是一种替代方法，利用通常库存和低成本设备进行靶向荧光镜引导实质穿刺。

知识进展

所介绍的技术是一种新的替代 TIPS 技术的初步描述，在具有挑战性的情况下可能值得考虑。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f8b2/9733616/230deb6565f2/bjr.20220556.g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f8b2/9733616/aad9e9230ab5/bjr.20220556.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f8b2/9733616/fb3cdf058357/bjr.20220556.g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f8b2/9733616/573dd7586fae/bjr.20220556.g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f8b2/9733616/b071aab4c014/bjr.20220556.g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f8b2/9733616/230deb6565f2/bjr.20220556.g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f8b2/9733616/aad9e9230ab5/bjr.20220556.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f8b2/9733616/fb3cdf058357/bjr.20220556.g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f8b2/9733616/573dd7586fae/bjr.20220556.g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f8b2/9733616/b071aab4c014/bjr.20220556.g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f8b2/9733616/230deb6565f2/bjr.20220556.g005.jpg

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