Kang Richard D, Nezami Nariman, Park Peter, DePalma Anthony A, Loya Mohammed F, Mhaskar Rahul, Engel Chad, Zwiebel Bruce, Hoots Glenn, Shaikh Jamil
University of South Florida, Morsani College of Medicine, Tampa, FL, USA.
Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
CVIR Endovasc. 2023 Apr 19;6(1):24. doi: 10.1186/s42155-023-00366-x.
Transjugular intrahepatic portosystemic shunt (TIPS) creation remains as one of the more technically challenging endovascular procedures. Portal vein access from the hepatic vein often requires multiple needle passes, which increases procedure times, risk of complications, and radiation exposure. With its bi-directional maneuverability, the Scorpion X access kit may be a promising tool for easier portal vein access. However, the clinical safety and feasibility of this access kit has yet to be determined.
In this retrospective study, 17 patients (12 male, average age 56.6 ± 9.01) underwent TIPS procedure using Scorpion X portal vein access kits. The primary endpoint was time taken to access the portal vein from the hepatic vein. The most common indications for TIPS were refractory ascites (47.1%) and esophageal varices (17.6%). Radiation exposure, total number of needle passes, and intraoperative complications were recorded. Average MELD Score was 12.6 ± 3.39 (range: 8-20).
Portal vein cannulation was successfully achieved in 100% of patients during intracardiac echocardiography-assisted TIPS creation. Total fluoroscopy time was 39.31 ± 17.97 min; average radiation dose was 1036.76 ± 644.15 mGy, while average contrast dose was 120.59 ± 56.87 mL. The average number of passes from the hepatic vein to the portal vein was 2 (range: 1-6). Average time to access the portal vein once the TIPS cannula was positioned in the hepatic vein was 30.65 ± 18.64 min. There were no intraoperative complications.
Clinical utilization of the Scorpion X bi-directional portal vein access kit is both safe and feasible. Utilizing this bi-directional access kit resulted in successful portal vein access with minimal intraoperative complications.
Retrospective cohort.
经颈静脉肝内门体分流术（TIPS）仍是技术要求较高的血管内介入手术之一。从肝静脉进入门静脉通常需要多次穿刺，这会增加手术时间、并发症风险和辐射暴露。凭借其双向可操作性，Scorpion X穿刺套件可能是一种有助于更轻松进入门静脉的有前景的工具。然而，该穿刺套件的临床安全性和可行性尚未确定。
在这项回顾性研究中，17例患者（12例男性，平均年龄56.6±9.01岁）使用Scorpion X门静脉穿刺套件进行了TIPS手术。主要终点是从肝静脉进入门静脉所需的时间。TIPS最常见的适应证是顽固性腹水（47.1%）和食管静脉曲张（17.6%）。记录辐射暴露、穿刺总次数和术中并发症。平均终末期肝病模型（MELD）评分是12.6±3.39（范围：8 - 20）。
在心脏超声心动图辅助下进行TIPS手术时，100%的患者成功实现门静脉插管。透视总时间为39.31±17.97分钟；平均辐射剂量为1036.76±644.15毫戈瑞，而平均造影剂剂量为120.59±56.87毫升。从肝静脉到门静脉的平均穿刺次数为2次（范围：1 - 6次）。一旦TIPS套管置于肝静脉，进入门静脉的平均时间为30.65±18.64分钟。无术中并发症。
Scorpion X双向门静脉穿刺套件的临床应用安全可行。使用这种双向穿刺套件可成功进入门静脉，且术中并发症最少。
回顾性队列研究。
