Hung Matthew L, Jairam Abhishek, Carr Matthew, Berman Zachary T, Taddonio Michael, Minocha Jeet, Aryafar Hamed, Mondschein Jeffrey I, Soulen Michael C, Nadolski Gregory J, Redmond Jonas
Department of Radiology, Stanford University School of Medicine, Stanford, CA 94305, United States.
Department of Radiology, University of California San Diego Medical Center, San Diego, CA 92037, United States.
World J Hepatol. 2025 May 27;17(5):106892. doi: 10.4254/wjh.v17.i5.106892.
The use of intravascular ultrasound (iUS) has been shown in multiple single-center retrospective studies to decrease procedure time, radiation exposure, and needle passes compared to conventional fluoroscopic guidance in the creation of a transjugular intrahepatic portosystemic shunt (TIPS). However, there are few data regarding the impact of imaging guidance modality choice on clinical outcomes.
To determine the impact of iUS fluoroscopic guidance during creation of a TIPS on procedural metrics, liver injury, shunt patency and mortality.
The retrospective study cohort consisted of 66 patients who underwent TIPS creation using iUS ["iUS-guided TIPS (iTIPS) group"] and 135 patients who underwent TIPS creation using fluoroscopic guidance ["conventional fluoroscopic-guided TIPS (cTIPS) group"] at 2 tertiary academic medical centers from 2015-2019. TIPS that required variceal embolization or portal vein recanalization were excluded.
The technical success rate was 100% in the iTIPS group and 96% in the cTIPS group ( = 0.17). The iTIPS group had an air kerma (266 ± 254 mGy 1235 ± 1049 mGy, < 0.00001), dose area product (5728 ± 6518 uGy × m 28969 ± 19067 uGy × m, < 0.00001), fluoroscopy time (18.7 ± 9.6 minutes 32.3 ± 19.0 minutes, < 0.00001), and total procedure time (93 ± 40 minutes 110 ± 51 minutes, = 0.01) which were significantly lower than the cTIPS group. There was no significant difference in liver function test adverse event grade at 1 month. With a median follow-up of 26 months (inter quartile range: 6-61 months), there was no difference between the two groups in terms of thrombosis-free survival ( = 0.23), intervention-free survival ( = 0.29), or patient mortality ( = 0.61).
The use of iUS in the creation of TIPS reduces radiation exposure and procedure time compared with fluoroscopic guidance. At midterm follow-up, the imaging guidance modality did not affect shunt patency or mortality.
多项单中心回顾性研究表明，与传统透视引导相比，在建立经颈静脉肝内门体分流术（TIPS）时使用血管内超声（iUS）可减少手术时间、辐射暴露和穿刺次数。然而，关于成像引导方式的选择对临床结局影响的数据较少。
确定在建立TIPS过程中使用iUS与透视引导对手术指标、肝损伤、分流道通畅情况和死亡率的影响。
回顾性研究队列包括2015年至2019年在2家三级学术医疗中心接受iUS引导建立TIPS的66例患者["iUS引导TIPS（iTIPS）组"]和接受透视引导建立TIPS的135例患者["传统透视引导TIPS（cTIPS）组"]。排除需要进行曲张静脉栓塞或门静脉再通的TIPS。
iTIPS组的技术成功率为100%，cTIPS组为96%（P = 0.17）。iTIPS组的空气比释动能（266±254 mGy比1235±1049 mGy，P < 0.00001）、剂量面积乘积（5728±6518 uGy×m比28969±19067 uGy×m，P < 0.00001）、透视时间（18.7±9.6分钟比32.3±19.0分钟，P < 0.00001）和总手术时间（93±40分钟比110±51分钟，P = 0.01）均显著低于cTIPS组。1个月时肝功能检查不良事件分级无显著差异。中位随访26个月（四分位间距：6 - 61个月），两组在无血栓生存（P = 0.23）、无需干预生存（P = 0.29）或患者死亡率（P = 0.61）方面无差异。
与透视引导相比，在建立TIPS时使用iUS可减少辐射暴露和手术时间。在中期随访中，成像引导方式不影响分流道通畅情况或死亡率。
