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CardioVascular and Interventional Radiology
Published in: CardioVascular and Interventional Radiology 2/2016

01-02-2016 | Clinical Investigation

Radiation Exposure in Transjugular Intrahepatic Portosystemic Shunt Creation

Authors: Roberto Miraglia, Luigi Maruzzelli, Kelvin Cortis, Mario D’Amico, Gaetano Floridia, Giuseppe Gallo, Corrado Tafaro, Angelo Luca

Published in: CardioVascular and Interventional Radiology | Issue 2/2016

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Abstract

Purpose

Transjugular intrahepatic portosystemic shunt (TIPS) creation is considered as being one of the most complex procedures in abdominal interventional radiology. Our aim was twofold: quantification of TIPS-related patient radiation exposure in our center and identification of factors leading to reduced radiation exposure.

Materials and methods

Three hundred and forty seven consecutive patients underwent TIPS in our center between 2007 and 2014. Three main procedure categories were identified: Group I (n = 88)—fluoroscopic-guided portal vein targeting, procedure done in an image intensifier-based angiographic system (IIDS); Group II (n = 48)—ultrasound-guided portal vein puncture, procedure done in an IIDS; and Group III (n = 211)—ultrasound-guided portal vein puncture, procedure done in a flat panel detector-based system (FPDS). Radiation exposure (dose-area product [DAP], in Gy cm2 and fluoroscopy time [FT] in minutes) was retrospectively analyzed.

Results

DAP was significantly higher in Group I (mean ± SD 360 ± 298; median 287; 75th percentile 389 Gy cm2) as compared to Group II (217 ± 130; 178; 276 Gy cm2; p = 0.002) and Group III (129 ± 117; 70; 150 Gy cm2 p < 0.001). The difference in DAP between Groups II and III was also significant (p < 0.001). Group I had significantly longer FT (25.78 ± 13.52 min) as compared to Group II (20.45 ± 10.87 min; p = 0.02) and Group III (19.76 ± 13.34; p < 0.001). FT was not significantly different between Groups II and III (p = 0.73).

Conclusions

Real-time ultrasound-guided targeting of the portal venous system during TIPS creation results in a significantly lower radiation exposure and reduced FT. Further reduction in radiation exposure can be achieved through the use of modern angiographic units with FPDS.
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Metadata
Title
Radiation Exposure in Transjugular Intrahepatic Portosystemic Shunt Creation
Authors
Roberto Miraglia
Luigi Maruzzelli
Kelvin Cortis
Mario D’Amico
Gaetano Floridia
Giuseppe Gallo
Corrado Tafaro
Angelo Luca
Publication date
01-02-2016
Publisher
Springer US
Published in
CardioVascular and Interventional Radiology / Issue 2/2016
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-015-1164-6

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