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01-07-2020 | Ascites | ABDOMINAL RADIOLOGY

Radiation exposure during transjugular intrahepatic portosystemic shunt creation in patients with complete portal vein thrombosis or portal cavernoma

Authors: Roberto Miraglia, Luigi Maruzzelli, Christine Cannataci, Roberta Gerasia, Giuseppe Mamone, Kelvin Cortis, Biagio Cimò, Ioannis Petridis, Riccardo Volpes, Angelo Luca

Published in: La radiologia medica | Issue 7/2020

Abstract

Background

This study aims to evaluate radiation exposure in patients with complete portal vein thrombosis (CPVT) or portal cavernoma (PC) undergoing transjugular intrahepatic portosystemic shunt (TIPS) creation using real-time ultrasound guidance for portal vein targeting.

Materials and methods

This is a single institution retrospective analysis. Between August 2009 and September 2018, TIPS was attempted in 49 patients with CPVT or PC. Radiation exposure (dose area product [DAP], air KERMA (AK) and fluoroscopy time [FT]), technical success, clinical success, complications and survival were analyzed.

Results

In total, 29 patients had CPVT and 20 patients had PC. 41/49 patients had cirrhosis. TIPS indications were refractory ascites (n = 25), variceal bleeding (n = 16) and other (n = 8). TIPS was successfully placed in 94% (46/49) of patients via a transjugular approach alone (n = 40), a transjugular/transhepatic approach (n = 5) and a transjugular/transsplenic approach (n = 1). Median DAP was 261 Gy * cm² (range 29–950), median AK was 0.2 Gy (range 0.05–0.5), and median FT was 28.2 min (range 7.7–93.7). Mean portosystemic pressure gradient decreased from 16.8  ±  5.1 mmHg to 7.5  ±  3.3 mmHg (P <  0.01). There were no major procedural complications. Overall clinical success was achieved in 77% of patients (mean follow-up of 21.1 months). Encephalopathy was observed in 16 patients (34%), grade II–III encephalopathy in 7 patients (15%). TIPS revision was performed in 15 patients (32%). Overall survival rate was 75%.

Conclusion

In our experience, the use of real-time ultrasound guidance allowed the majority of the TIPS to be performed via a transjugular approach alone with a reasonably low radiation exposure considering the high technical difficulties of the selected cohort of patients with CVPT or PC.

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Title: Radiation exposure during transjugular intrahepatic portosystemic shunt creation in patients with complete portal vein thrombosis or portal cavernoma
Authors: Roberto Miraglia
Luigi Maruzzelli
Christine Cannataci
Roberta Gerasia
Giuseppe Mamone
Kelvin Cortis
Biagio Cimò
Ioannis Petridis
Riccardo Volpes
Angelo Luca
Publication date: 01-07-2020
Publisher: Springer Milan
Keywords: Ascites
Portal Vein Thrombosis
Portal Vein Thrombosis
Hepatic Encephalopathy
Hepatic Encephalopathy
Published in: La radiologia medica / Issue 7/2020
Print ISSN: 0033-8362
Electronic ISSN: 1826-6983
DOI: https://doi.org/10.1007/s11547-020-01155-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Radiation exposure during transjugular intrahepatic portosystemic shunt creation in patients with complete portal vein thrombosis or portal cavernoma

Abstract

Background

Materials and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusion

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