Ultrasonographic guidance for portal vein access during transjugular intrahepatic portosystemic shunt (TIPS) placement

Purpose: The purpose of our study was to retrospectively assess the safety and efficacy of percutaneous real-time ultrasound guidance for portal vein puncture during transjugular intrahepatic portosystemic shunt (TIPS) placement. Materials and methods: Between January 2011 and November 2018, procedure details and outcome were retrospectively analyzed for 224 patients who underwent TIPS placement using real-time ultrasound guidance for portal vein puncture. There were 175 men and 49 women with a mean age of 52.7 +/- 10.6 (SD) years (range: 22-82 years). For each procedure, technical success, primary ultrasound guidance success, portosystemic pressure gradient, duration of the intervention, procedural complications, radiation exposure, mortality and morbidity rates at day 30 post-procedure were recorded for data analysis. Results: Technical success rate was 100.0% with a success rate of the primary ultrasound guidance of 97.8% (219/224; 95% CI: 95.8-99.7). Mean duration of the procedure was 86.2 *41.7 (SD) min (range: 22.0-267.0 min). Mean dose-area product was 62.0 + 50.2 (SD) Gy.cm2 (range: 3.7-306.5 Gy.cm(2)). Twelve complications (12/224; 5.4%) occurred in ten patients during TIPS procedures including 8 arterial punctures (3.6%) and 4 biliary punctures (1.8%). Four complications (4/224; 1.8%) were clinically significant. Mortality rate at day 30 after the procedure was 9.8% (22/224), without any patient dying from technical complications. Conclusion: Real-time ultrasound guidance is a safe technique to assist in the creation of TIPS and may allow for lower radiation exposure. (C) 2019 Societe francaise de radiologie. Published by Elsevier Masson SAS. All rights reserved.