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Tytuł pozycji:

Ultrasound-Guided Portal Vein Access and Percutaneous Wire Placement in the Portal Vein Are Associated With Shorter Procedure Times and Lower Radiation Doses During TIPS Placement.

Tytuł :
Ultrasound-Guided Portal Vein Access and Percutaneous Wire Placement in the Portal Vein Are Associated With Shorter Procedure Times and Lower Radiation Doses During TIPS Placement.
Autorzy :
Cam I; Department of Radiology, Division of Interventional Radiology, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455.
Gencturk M; Department of Radiology, University of Minnesota, Minneapolis, MN.
Shrestha P; Department of Radiology, Division of Interventional Radiology, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455.
Golzarian J; Department of Radiology, Division of Interventional Radiology, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455.
Flanagan S; Department of Radiology, Division of Interventional Radiology, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455.
Lim N; Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, MN.
Young S; Department of Radiology, Division of Interventional Radiology, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455.
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Źródło :
AJR. American journal of roentgenology [AJR Am J Roentgenol] 2021 May; Vol. 216 (5), pp. 1291-1299. Date of Electronic Publication: 2020 Jul 29.
Typ publikacji :
Journal Article
Język :
English
Imprint Name(s) :
Publication: <2004-> : Leesburg, VA : American Roentgen Ray Society
Original Publication: Springfield, Ill., Thomas.
MeSH Terms :
Operative Time*
Radiation Dosage*
Portal Vein/*diagnostic imaging
Portasystemic Shunt, Transjugular Intrahepatic/*instrumentation
Portasystemic Shunt, Transjugular Intrahepatic/*methods
Ultrasonography, Interventional/*methods
Adult ; Female ; Humans ; Male ; Middle Aged
Contributed Indexing :
Keywords: TIPS*; imaging guidance*; portal hypertension*; portal vein puncture*
Entry Date(s) :
Date Created: 20200807 Date Completed: 20210510 Latest Revision: 20210510
Update Code :
20210511
DOI :
10.2214/AJR.20.23846
PMID :
32755214
Czasopismo naukowe
BACKGROUND. TIPS placement is an effective method for treating a number of complications of portal hypertension. Although this complex procedure has been firmly established in treatment algorithms, more data are needed to determine the most efficient and safest ways to perform the procedure. OBJECTIVE. The purpose of this study was to determine the effect of three different techniques of portal vein (PV) cannulation during TIPS placement on procedure efficiency. METHODS. The medical records of patients who underwent TIPS creation between 2005 and 2019 were reviewed. On the basis of the PV access technique used, patients were grouped as follows: group 1 (G1) included patients who underwent a transabdominal ultrasound (US)-guided technique to obtain PV access, group 2 (G2) consisted of those who underwent fluoroscopically guided wedged hepatic portography, and group 3 (G3) included those who underwent percutaneous US-guided PV guidewire placement for fluoroscopic targeting. RESULTS. Of the 264 patients who underwent TIPS creation, 54 (20.5%) were in G1, 172 (65.1%) were in G2, and 38 (14.4%) were in G3. The mean (± SD) fluoroscopic time in G1 (34.8 ± 16.6 minutes) did not differ from that in either G2 (38.9 ± 20.8 minutes; p = .09) or G3 (29.5 ± 14.6 minutes; p = .06). However, G2 patients had significantly longer fluoroscopic times than G3 patients ( p = .005). The mean total anesthesia time in G1 (190.2 ± 45.6 minutes) did not differ from that in G2 (199.7 ± 59.5 minutes; p = .15). However, G3 had a mean anesthesia time (162.6 ± 39.7 minutes) that was significantly shorter than that in both G1 ( p = .003) and G2 ( p < .001). The mean contrast volume was significantly lower in G1 than in G2 (67.9 ± 36.8 mL vs 87.1 ± 42.9 mL; p = .005). More intrahepatic needle passes were required in G2 (median, 4 passes; interquartile range [IQR], 1-7 passes) than in G1 (median, 2 passes; IQR, 1-4 passes; p = .004) and G3 (median, 2 passes; IQR, 1-7.25 passes; p = .04). When complications in G1 and G3 were pooled, this cohort had significantly fewer complications than G2 ( p = .01). CONCLUSION. Ultrasound-guided PV access and percutaneous PV guidewire placement for fluoroscopic targeting during TIPS creation are associated with shorter procedure and fluoroscopic times and potentially decreased complications. CLINICAL IMPACT. The present study helps interventional radiologists understand the safest and most efficient way to access the PV, which is a key step during TIPS placement.
Comment in: AJR Am J Roentgenol. 2020 Aug 19;:. (PMID: 32812794)
Comment in: AJR Am J Roentgenol. 2021 May;216(5):W15. (PMID: 33729877)
Comment in: AJR Am J Roentgenol. 2021 May;216(5):W16. (PMID: 33760650)

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