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

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

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)609-617
Number of pages9
JournalRadiol. Med.
Volume125
Issue number7
DOIs
Publication statusPublished - Jul 2020

Keywords

  • Esophageal and Gastric Varices/diagnostic imaging
  • Female
  • Fluoroscopy
  • Gastrointestinal Hemorrhage/diagnostic imaging
  • Hemangioma, Cavernous/diagnostic imaging
  • Humans
  • Liver Neoplasms/diagnostic imaging
  • Male
  • Middle Aged
  • Portal Vein/diagnostic imaging
  • Portasystemic Shunt, Transjugular Intrahepatic
  • Radiation Exposure
  • Retrospective Studies
  • Ultrasonography, Interventional
  • Venous Thrombosis/diagnostic imaging

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