Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. May 27, 2025; 17(5): 106892
Published online May 27, 2025. doi: 10.4254/wjh.v17.i5.106892
Transjugular intrahepatic portosystemic shunt creation using intravascular ultrasound vs fluoroscopic guidance: A dual-institution retrospective comparative study
Matthew L Hung, Abhishek Jairam, Matthew Carr, Zachary T Berman, Michael Taddonio, Jeet Minocha, Hamed Aryafar, Jeffrey I Mondschein, Michael C Soulen, Gregory J Nadolski, Jonas Redmond
Matthew L Hung, Department of Radiology, Stanford University School of Medicine, Stanford, CA 94305, United States
Abhishek Jairam, Zachary T Berman, Michael Taddonio, Jeet Minocha, Jonas Redmond, Department of Radiology, University of California San Diego Medical Center, San Diego, CA 92037, United States
Matthew Carr, Department of Radiology, University of California Los Angeles, Los Angeles, CA 90095, United States
Hamed Aryafar, Department of Radiology, Sharp Memorial Hospital, San Diego, CA 92123, United States
Jeffrey I Mondschein, Michael C Soulen, Gregory J Nadolski, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, United States
Author contributions: Hung ML, Jairam A, and Carr M contributed to methodology, data curation and formal analysis; Hung ML, Berman ZT, Taddonio M, Minocha J, Aryafar H, Mondschein JI, Soulen MC, Nadolski GJ, and Redmond J contributed to the writing, reviewing and editing of the manuscript; Nadolski GJ, Redmond J were responsible for conceptualization of the project; and all authors thoroughly reviewed and endorsed the final manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Hospital of the University of Pennsylvania, approval No. 822828.
Informed consent statement: Informed consent was not required for this retrospective study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Data supporting the findings of this study are available upon request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Matthew L Hung, MD, Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive MC 5105, Stanford, CA 94305, United States. mlhung@stanford.edu
Received: March 11, 2025
Revised: April 8, 2025
Accepted: April 25, 2025
Published online: May 27, 2025
Processing time: 77 Days and 16.7 Hours
Abstract
BACKGROUND

The use of intravascular ultrasound (iUS) has been shown in multiple single-center retrospective studies to decrease procedure time, radiation exposure, and needle passes compared to conventional fluoroscopic guidance in the creation of a transjugular intrahepatic portosystemic shunt (TIPS). However, there are few data regarding the impact of imaging guidance modality choice on clinical outcomes.

AIM

To determine the impact of iUS vs fluoroscopic guidance during creation of a TIPS on procedural metrics, liver injury, shunt patency and mortality.

METHODS

The retrospective study cohort consisted of 66 patients who underwent TIPS creation using iUS [“iUS-guided TIPS (iTIPS) group”] and 135 patients who underwent TIPS creation using fluoroscopic guidance [“conventional fluoroscopic-guided TIPS (cTIPS) group”] at 2 tertiary academic medical centers from 2015-2019. TIPS that required variceal embolization or portal vein recanalization were excluded.

RESULTS

The technical success rate was 100% in the iTIPS group and 96% in the cTIPS group (P = 0.17). The iTIPS group had an air kerma (266 ± 254 mGy vs 1235 ± 1049 mGy, P < 0.00001), dose area product (5728 ± 6518 uGy × m2vs 28969 ± 19067 uGy × m2, P < 0.00001), fluoroscopy time (18.7 ± 9.6 minutes vs 32.3 ± 19.0 minutes, P < 0.00001), and total procedure time (93 ± 40 minutes vs 110 ± 51 minutes, P = 0.01) which were significantly lower than the cTIPS group. There was no significant difference in liver function test adverse event grade at 1 month. With a median follow-up of 26 months (inter quartile range: 6-61 months), there was no difference between the two groups in terms of thrombosis-free survival (P = 0.23), intervention-free survival (P = 0.29), or patient mortality (P = 0.61).

CONCLUSION

The use of iUS in the creation of TIPS reduces radiation exposure and procedure time compared with fluoroscopic guidance. At midterm follow-up, the imaging guidance modality did not affect shunt patency or mortality.

Keywords: Portal hypertension; Transjugular intrahepatic portosystemic shunt; Radiation; Intravascular ultrasound; Shunt patency

Core Tip: A comparison of intravascular ultrasound vs fluoroscopic guidance in the creation of a transjugular intrahepatic portosystemic shunt demonstrates that imaging guidance modality has no impact on shunt patency or mortality in intermediate-term follow-up, or liver injury at 1 month. However, the use of intravascular ultrasound decreases radiation exposure and procedure time compared to fluoroscopic guidance. Imaging guidance modality therefore affects procedural metrics, but does not appear to impact subsequent clinical outcomes.