TY - JOUR
T1 - Intravascular Ultrasound Guidance for TIPS Procedures
T2 - A Review
AU - Dastmalchian, Sara
AU - Aryafar, Hamed
AU - Tavri, Sidhartha
N1 - Publisher Copyright:
© American Roentgen Ray Society.
PY - 2022/10
Y1 - 2022/10
N2 - The most challenging and time-consuming step of TIPS procedures is obtaining appropriate portal vein (PV) access. Given the lack of real-time direct target visualization, conventional fluoroscopic guidance requires multiple passes, contributing to complications. In comparison, intravascular ultrasound (IVUS) guidance during TIPS procedures provides direct visualization of hepatic structures and real-time guidance for PV puncture. IVUS guidance during TIPS creation improves procedural metrics such as radiation dose, contrast agent volume, procedure time, and technical success rate and is particularly beneficial in technically challenging cases (e.g., in patients portal vein thrombosis, small or variant portal vein anatomy, Budd-Chiari syndrome, or liver masses). The purpose of this review is to summarize current IVUS technology, describe the technical aspects of IVUS-guided TIPS creation, and discuss the clinical indications for and benefits of using IVUS for TIPS creation, while presenting available evidence supporting the technique’s use. Given the improved safety profile and overall success rate in comparison with conventional guidance methods, IVUS guidance has the future potential to become the standard practice for TIPS placement.
AB - The most challenging and time-consuming step of TIPS procedures is obtaining appropriate portal vein (PV) access. Given the lack of real-time direct target visualization, conventional fluoroscopic guidance requires multiple passes, contributing to complications. In comparison, intravascular ultrasound (IVUS) guidance during TIPS procedures provides direct visualization of hepatic structures and real-time guidance for PV puncture. IVUS guidance during TIPS creation improves procedural metrics such as radiation dose, contrast agent volume, procedure time, and technical success rate and is particularly beneficial in technically challenging cases (e.g., in patients portal vein thrombosis, small or variant portal vein anatomy, Budd-Chiari syndrome, or liver masses). The purpose of this review is to summarize current IVUS technology, describe the technical aspects of IVUS-guided TIPS creation, and discuss the clinical indications for and benefits of using IVUS for TIPS creation, while presenting available evidence supporting the technique’s use. Given the improved safety profile and overall success rate in comparison with conventional guidance methods, IVUS guidance has the future potential to become the standard practice for TIPS placement.
KW - IVUS
KW - TIPS
KW - intravascular ultrasound
KW - portal hypertension
KW - portal vein access
UR - http://www.scopus.com/inward/record.url?scp=85138489678&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85138489678&partnerID=8YFLogxK
U2 - 10.2214/AJR.22.27626
DO - 10.2214/AJR.22.27626
M3 - Review article
C2 - 35583424
AN - SCOPUS:85138489678
SN - 0361-803X
VL - 219
SP - 634
EP - 646
JO - American Journal of Roentgenology
JF - American Journal of Roentgenology
IS - 4
ER -