Abstract
Purpose
To assess the impact of anatomical, procedural, and operator skill factors on the success and duration of fluoroscopy-guided transjugular intrahepatic portoystemic shunt following standard operating procedure (SOP).
Material and Methods
During a 32-month period, 102 patients underwent transjugular intrahepatic portosystemic shunt creation (TIPS) by two interventional radiologists (IR) following our institutional SOP based on fluoroscopy guidance. Both demographic and procedural data were assessed. The duration of the intervention (D Int) and of the portal vein puncture (D Punct) was analyzed depending on the skill level of the IR as well as the anatomic or procedural factors.
Results
In 99 of the 102 patients, successful TIPS without peri-procedural complications was performed. The mean D Int (IR1: 77 min; IR2: 51 min, P < 0.005) and the mean D Punct (IR1: 19 min; IR2: 13 min, P < 0.005) were significantly higher in TIPS performed by IR1 (with 2 years of clinical experience performing TIPS, n = 38) than by IR2 (>10 years of clinical experience performing TIPS, n = 61), (P < 0.005 both, Mann–Whitney U test). D Int showed a higher correlation with D Punct for IR2 (R 2 = 0.63) than for IR1 (R 2 = 0.13). There was no significant difference in the D Punct for both IRs with regard to the success of the wedged portography (P = 0.90), diameter of the portal vein (P = 0.60), central right portal vein length (P = 0.49), or liver function (MELD-Score before the TIPS procedure; P = 0.14).
Conclusion
TIPS following SOP is safe, fast, and reliable. The only significant factor for shorter D Punct and D Int was the clinical experience of the IR. Anatomic variability, successful portography, or liver function did not alter the duration or technical success of TIPS.
Similar content being viewed by others
References
Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PC (2000) A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology 31(4):864–871
Kamath PS, Kim WR (2007) The model for end-stage liver disease (MELD). Hepatology 45(3):797–805
Garcia-Tsao G, Groszmann RJ, Fisher RL, Conn HO, Atterbury CE, Glickman M (1985) Portal pressure, presence of gastroesophageal varices and variceal bleeding. Hepatology 5(3):419–424
Fidelman N, Kwan SW, LaBerge JM, Gordon RL, Ring EJ, Kerlan RK Jr (2012) The transjugular intrahepatic portosystemic shunt: an update. AJR Am J Roentgenol 199(4):746–755
Sorensen HT, Thulstrup AM, Mellemkjar L et al (2003) Long-term survival and cause-specific mortality in patients with cirrhosis of the liver: a nationwide cohort study in Denmark. J Clin Epidemiol 56(1):88–93
Farsad K, Fuss C, Kolbeck KJ et al (2012) Transjugular intrahepatic portosystemic shunt creation using intravascular ultrasound guidance. J Vasc Interv Radiol 23(12):1594–1602
Kapoor BS, Esparaz A, Levitin A, McLennan G, Moon E, Sands M (2013) Nonvascular and portal vein applications of cone-beam computed tomography: current status. Tech Vasc Interv Radiol 16(3):150–160
Kee ST, Ganguly A, Daniel BL et al (2005) MR-guided transjugular intrahepatic portosystemic shunt creation with use of a hybrid radiography/MR system. J Vasc Interv Radiol 16(2 Pt 1):227–234
Hamid RS, Azeemuddin M, Sajjad Z, Chishti I, Hamid RS, Salam B (2011) Transjugular intrahepatic portosystemic shunt (TIPS): review of initial experience at Aga Khan University Hospital. The JPMA. J Pak Med Assoc 61(4):336–339
Gaba RC, Omene BO, Podczerwinski ES et al (2012) TIPS for treatment of variceal hemorrhage: clinical outcomes in 128 patients at a single institution over a 12-year period. J Vasc Interv Radiol 23(2):227–235
Wang HB, Zhang AZ, Yang CM et al (2012) Transjugular intrahepatic portosystemic shunt plus embolotherapy in the treatment of gastroesophageal varices: a report of 38 patients. Zhonghua yi xue za zhi 92(6):411–413
Zweers D, Geleijns J, Aarts NJ et al (1998) Patient and staff radiation dose in fluoroscopy-guided TIPS procedures and dose reduction, using dedicated fluoroscopy exposure settings. Br J Radiol 71(846):672–676
Hidajat N, Wust P, Kreuschner M, Felix R, Schroder RJ (2006) Radiation risks for the radiologist performing transjugular intrahepatic portosystemic shunt (TIPS). Br J Radiol 79(942):483–486
Miller DL, Kwon D, Bonavia GH (2009) Reference levels for patient radiation doses in interventional radiology: proposed initial values for U.S. practice. Radiology 253(3):753–764
EDI EDdI, BAG BfG, Verbraucherschutz D. Merkblatt R-06-05 Diagnostische Referenzwerte für die Interventionelle Radiologie und die Kardiologie. In: EDI EDdI, BAG BfG, Verbraucherschutz D, eds. http://www.bag.admin.ch/themen/strahlung/10463/10958/index.html?lang=de&download=NHzLpZig7t,lnp6I0NTU042l2Z6ln1acy4Zn4Z2qZpnO2Yuq2Z6gpJCGfYF4e2ym162dpYbUzd,Gpd6emK2Oz9aGodetmqaN19XI2IdvoaCVZ,s-2008. Accessed Feb 2014
Network EMA. Optimisation of patient and occupational exposure in interventional radiology. In: Network EMA, ed. http://www.eman-network.eu/IMG/pdf/WG2_Final_Report-2.pdf2012. Accessed Feb 2014
Gaba RC, Khiatani VL, Knuttinen MG et al (2011) Comprehensive review of TIPS technical complications and how to avoid them. AJR Am J Roentgenol 196(3):675–685
Acknowledgment
There were no other individuals involved and no Grant given for this work.
Conflict of interest
There is no conflict of interest to be declared by any of the authors.
Statement of Human and Animal Rights
For this type of study formal consent is not required.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Marquardt, S., Rodt, T., Rosenthal, H. et al. Impact of Anatomical, Procedural, and Operator Skill Factors on the Success and Duration of Fluoroscopy-Guided Transjugular Intrahepatic Portosystemic Shunt. Cardiovasc Intervent Radiol 38, 903–912 (2015). https://doi.org/10.1007/s00270-014-1035-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00270-014-1035-6