Published online Aug 27, 2025. doi: 10.4254/wjh.v17.i8.109496
Revised: June 17, 2025
Accepted: July 25, 2025
Published online: August 27, 2025
Processing time: 106 Days and 8.3 Hours
A recent study in World Journal of Hepatology examined the use of intravascular ultrasound (IVUS) for transjugular intrahepatic portosystemic shunt (TIPS) creation. The study concluded that IVUS significantly reduces procedure time, radiation exposure, and the number of needle passes compared to conventional fluoroscopic guidance. IVUS offers real-time visualization of the portal vein, but challenges remain in terms of equipment costs and the operator learning curve. TIPS creation techniques vary widely in clinical practice, where methods, such as conventional fluoroscopy, three-dimensional image fusion, electromagnetic navigation, and IVUS, are commonly employed. In this editorial, we provide a comparative analysis of these methods based on clinical experience and the literature. By evaluating the strengths and limitations of each technique, we aim to inform clinical decision-making and enhance procedural outcomes. Future developments in TIPS creation are likely to focus on hybrid techniques that combine the strengths of IVUS, electromagnetic navigation, and real-time image fusion, potentially leading to more precise, cost-effective, and accessible methods.
Core Tip: This study compares intravascular ultrasound (IVUS) with conventional techniques for transjugular intrahepatic portosystemic shunt (TIPS) creation. IVUS reduces procedure time, radiation exposure, and needle passes while enhancing precision. Despite higher initial costs, IVUS offers long-term savings through faster procedures and reduced complications. Emerging technologies, such as artificial intelligence integration and miniaturized devices, promise to further improve IVUS-guided TIPS, making it a potentially cost-effective and universally applicable method in the future.