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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2021; 31(04): 858-866
DOI: 10.1055/s-0041-1735928
Original Article

Technical and Medium-Term Clinical Outcomes of Transjugular Intrahepatic Portosystemic Shunt with Fluoroscopy and Additional Trans-abdominal Ultrasound Guidance

Shyamkumar N. Keshava 
1   Department of Interventional Radiology, Christian Medical College, Vellore, Tamil Nadu, India
,
Vinu Moses 
1   Department of Interventional Radiology, Christian Medical College, Vellore, Tamil Nadu, India
,
Anand Sharma 
2   Department of Hepatology, Christian Medical College, Vellore, Tamil Nadu, India
,
Munawwar Ahmed 
1   Department of Interventional Radiology, Christian Medical College, Vellore, Tamil Nadu, India
,
Sathya Narayanan 
1   Department of Interventional Radiology, Christian Medical College, Vellore, Tamil Nadu, India
,
Aswin Padmanabhan 
1   Department of Interventional Radiology, Christian Medical College, Vellore, Tamil Nadu, India
,
Ashish Goel 
2   Department of Hepatology, Christian Medical College, Vellore, Tamil Nadu, India
,
Uday Zachariah 
2   Department of Hepatology, Christian Medical College, Vellore, Tamil Nadu, India
,
C.E. Eapen 
2   Department of Hepatology, Christian Medical College, Vellore, Tamil Nadu, India
› Author Affiliations Funding None.
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Abstract

Background and Objective The aim of the study is to evaluate the technical and clinical outcomes of transjugular intrahepatic portosystemic shunt (TIPS) performed with additional transabdominal ultrasound guidance.

Material and Methods Patients who underwent TIPS between January 2004 to January 2020 in our center were studied. Technical, hemodynamic, angiographic, and clinical outcome were recorded up to 1 year of follow-up.

Results TIPS was attempted in 162 patients (median [range] age 37[3–69] years; 105 were males and 57 were females; Etiology: Budd-Chiari syndrome [BCS] 91, cirrhosis 65, symptomatic acute portal venous thrombosis [PVT] 3, veno-occlusive disease [VOD] 2, congenital portosystemic shunt [CPSS] 1) during the study period. Indication for TIPS was refractory ascites in 135 patients (BCS 86, cirrhosis 49) and variceal bleed in 21 patients (BCS 5, cirrhosis 16). Technical success was seen in 161 of the 162 (99.4%) patients. The tract was created from hepatic vein in 55 patients and inferior vena cava (IVC) in 106 patients. Complications within 1 week post TIPS were seen in 29 of the 162 (18%) patients, of whom one developed unexplained arrhythmia and hypotension and died. Of the patients with available follow-up, clinical success was noted in 120 (81%), while 14 (9%) patients had partial nonresponse and six (4%) had complete nonresponse. Eight (5%) patients died during the follow-up period.

Conclusion The technical success of TIPS creation with additional transabdominal ultrasound guidance is very high with low peri-procedural complication rate. It has enabled the inclusion of a wider spectrum of cases like acute PVT and obliterated hepatic veins which were otherwise considered contraindications.

Keywords

transjugular intrahepatic portosystemic shunt - fluoroscopic - ultrasound

Ethical Approval

Obtained.




Publication History

Article published online:
30 November 2021

© 2021. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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