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Intravascular Ultrasound Guidance for Transjugular Intrahepatic Portosystemic Shunt Procedure in a Swine Model

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Abstract

A new method is described for guiding hepato-portal venous puncture using a longitudinal side-view intravascular ultrasound (L-IVUS) transducer to assist in the performance of transjugular intrahepatic portosystemic shunt (TIPS) in three Australian swine. Simultaneous L-IVUS with an AcuNav® 5–10 MHz 10 Fr transducer (Acuson Corporation, Mountain View, CA, USA) and fluoroscopy guidance was used to image and monitor the hepatic to portal venous puncture, dilatation of the tract, and deployment of the TIPS stent. Flow through the shunt could be demonstrated with both L-IVUS and angiography. TIPS was successful in all swine. The time for portal vein puncture once the target portal vein was identified was reduced at each attempt. The number of portal vein puncture attempts was 2, 1, and 1. No post-procedural complication was evident. L-IVUS-guided TIPS is practical and has the potential to improve safety by permitting simultaneous ultrasound and fluoroscopic imaging of the needle and target vascular structures. This technique allows for a more streamlined approach to TIPS, decreasing the fluoroscopic time (hence, decreasing the radiation exposure to the staff and patient) and anesthetic time. In addition, there are improved safety benefits obviating the need for wedged portography, facilitating avoidance of bile duct and hepatic arterial puncture, and minimizing hepatic injury by decreasing liver capsular puncture and the attendant risks.

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Acknowledgements

We thank the following for their contributions to the study: Stuart McGavin and Cheryl Quelch of NWAHS, Lyell McEwin Hospital Campus, Adelaide for their assistance operating the Sequoia ultrasound equipment. Acuson Pty Ltd Australia, Epping NSW, Australia for donation and use of the AcuNav® probe. Adrian Hines and Ken Porter of the Queen Elizabeth Animal House facilities for care of the animals used in the study. Michael Taylor, Queen Elizabeth Hospital Radiology for radiographic support.

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  1. Department of Radiology, North Western Adelaide Health Service, The Queen Elizabeth Hospital Campus, 28 Woodville Road, Woodville South, Adelaide, 5011, South Australia, Australia

    Jacqueline Kew & Roger P. Davies

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  1. Jacqueline Kew
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  2. Roger P. Davies
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Kew, J., Davies, R. Intravascular Ultrasound Guidance for Transjugular Intrahepatic Portosystemic Shunt Procedure in a Swine Model . CVIR 27, 38–41 (2004). https://doi.org/10.1007/s00270-003-2634-9

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