Division of Interventional Radiology, Department of Radiology, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC, 20007, USA.
Division of Interventional Radiology, Department of Radiology, Tufts Medical Center, 800 Washington St, Boston, MA, 02111, USA.
Cardiovasc Intervent Radiol. 2023 Sep;46(9):1238-1248. doi: 10.1007/s00270-023-03528-5. Epub 2023 Aug 14.
To review technical details, indications for use, success rates and complications of gun-sight technique for transjugular intra-hepatic portosystemic shunt (TIPS) creation.
A multicenter retrospective review was performed. Forty-two TIPS procedures with gun-sight technique were identified between 2016 and 2021. Eighty-six percent of patients had portal vein thrombosis (PVT), and 21% had undergone prior failed TIPS creation. Demographics, procedure details and outcomes were reviewed. Differences between the groups, event rates and patency rates were evaluated using nonparametric two-sample Wilcoxon rank-sum (Mann-Whitney) test, Fisher's exact test, Kaplan-Meier curves, and log-rank test.
Technical success was 98%. Sixty-seven percent of subjects had transsplenic and 26% had transhepatic access for TIPS creation. Twenty-one adverse events were noted (48%), four of which were definitely related and four were probably related to the use of gun-sight technique. Early (within 90 days) thrombosis occurred in 7/41 patients (17%), all of whom had existing PVT.
Gun-sight technique for TIPS creation has a high success rate in this challenging cohort of patients. While complications can occur, most of the adverse events noted were likely associated with TIPS creation itself rather than gun-sight. Early thrombosis only occurred in patients with PVT. Level of Evidence Level 4, Case Series.
回顾枪瞄技术经颈静脉肝内门体分流术（TIPS）创建的技术细节、适应证、成功率和并发症。
进行了一项多中心回顾性研究。2016 年至 2021 年期间，共发现 42 例采用枪瞄技术的 TIPS 手术。86%的患者存在门静脉血栓形成（PVT），21%的患者曾行失败的 TIPS 手术。回顾了患者的人口统计学资料、手术细节和结局。使用非参数两样本 Wilcoxon 秩和（Mann-Whitney）检验、Fisher 确切检验、Kaplan-Meier 曲线和对数秩检验评估组间差异、事件发生率和通畅率。
技术成功率为 98%。67%的患者采用经脾途径，26%的患者采用经肝途径进行 TIPS 手术。共发现 21 例不良事件（48%），其中 4 例与枪瞄技术的使用明确相关，4 例可能相关。41 例患者中有 7 例（17%）在早期（90 天内）发生血栓形成，均存在 PVT。
在这组具有挑战性的患者中，枪瞄技术用于 TIPS 手术创建具有较高的成功率。虽然可能发生并发症，但大多数不良事件很可能与 TIPS 手术本身有关，而非枪瞄技术。早期血栓形成仅发生在存在 PVT 的患者中。证据等级 4，病例系列。
