The Use of Intracardiac Echocardiography in Transjugular Intrahepatic Portosystemic Shunt Procedure

Abstract

Transjugular intrahepatic portosystemic shunt (TIPS) is a complex intervention with a steep learning curve that requires centers of expertise to improve technical success and reduce complications. Portal venous access is the most challenging step of the procedure and requires planning and image guidance strategies to prevent vascular or bile duct injury and further complications. Intracardiac echocardiography (ICE) has been reported to be a safe and accurate tool that provides images of the portal vein anatomy in real time. The use of ICE has become the standard of care in several centers. It is now frequently used to target the portal vein in complex TIPS procedures. This review article describes some technical aspects and indications of ICE-guided TIPS.

Keywords

transjugular intrahepatic portosystemic shunt - intracardiac echocardiography - portal vein - hepatic vein - interventional radiology

Financial Disclosures

The authors declare no financial disclosures.

Publication History

Article published online:
04 May 2023

• References

• 1 Colapinto RF, Blendis LM. Liver biopsy through the transjugular approach. Modification of instruments. Radiology 1983; 148 (01) 306-306
• 2 Rösch J, Hanafee WN, Snow H. Transjugular portal venography and radiologic portacaval shunt: an experimental study. Radiology 1969; 92 (05) 1112-1114
• 3 Gaba RC, Khiatani VL, Knuttinen MG. et al. Comprehensive review of TIPS technical complications and how to avoid them. AJR Am J Roentgenol 2011; 196 (03) 675-685
• 4 Copelan A, Kapoor B, Sands M. Transjugular intrahepatic portosystemic shunt: indications, contraindications, and patient work-up. Semin Intervent Radiol 2014; 31 (03) 235-242
• 5 Kew J, Davies RP. Intravascular ultrasound guidance for transjugular intrahepatic portosystemic shunt procedure in a swine model. Cardiovasc Intervent Radiol 2004; 27 (01) 38-41
• 6 Dastmalchian S, Aryafar H, Tavri S. Intravascular ultrasound guidance for TIPS procedures: a review. AJR Am J Roentgenol 2022; 219 (04) 634-646
• 7 Swenson C, Martin JG, Jaffe T. et al. Intravascular ultrasound-guided transvenous biopsy of abdominal and pelvic targets difficult to access by percutaneous needle biopsy: technique and initial clinical experience. J Vasc Interv Radiol 2021; 32 (09) 1310-1318.e2
• 8 Petersen B. Intravascular ultrasound-guided direct intrahepatic portacaval shunt: description of technique and technical refinements. J Vasc Interv Radiol 2003; 14 (01) 21-32
• 9 Farsad K, Fuss C, Kolbeck KJ. et al. Transjugular intrahepatic portosystemic shunt creation using intravascular ultrasound guidance. J Vasc Interv Radiol 2012; 23 (12) 1594-1602
• 10 Marquardt S, Rodt T, Rosenthal H, Wacker F, Meyer BC. Impact of anatomical, procedural, and operator skill factors on the success and duration of fluoroscopy-guided transjugular intrahepatic portosystemic shunt. Cardiovasc Intervent Radiol 2015; 38 (04) 903-912
• 11 Pillai AK, Andring B, Faulconer N. et al. Utility of intravascular US–guided portal vein access during transjugular intrahepatic portosystemic shunt creation: retrospective comparison with conventional technique in 109 patients. J Vasc Interv Radiol 2016; 27 (08) 1154-1159
• 12 Kao SD, Morshedi MM, Narsinh KH. et al. Intravascular ultrasound in the creation of transhepatic portosystemic shunts reduces needle passes, radiation dose, and procedure time: a retrospective study of a single-institution experience. J Vasc Interv Radiol 2016; 27 (08) 1148-1153
• 13 Ramaswamy RS, Charalel R, Guevara CJ. et al. Propensity-matched comparison of transjugular intrahepatic portosystemic shunt placement techniques: Intracardiac echocardiography (ICE) versus fluoroscopic guidance. Clin Imaging 2019; 57: 40-44