Meta-analysis of transjugular intrahepatic portosystemic shunt creation with intravascular ultrasound guidance

Qian Yu, Vascular and Interventional Radiology, Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois, 60637, USA.
Osman Ahmed, Vascular and Interventional Radiology, Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois, 60637, USA.
Subhash Gutti, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA.
Deepak Iyer, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA.
Daniel Kwak, Vascular and Interventional Radiology, Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois, 60637, USA.
Syed Samaduddin Ahmed, College of Osteopathic Medicine, Midwestern University Chicago, Chicago, Illinois, USA.
Adam Said, University of Illinois at Urbana-Champaign, Champaign, Illinois, USA.
J Fritz Angle, Vascular and Interventional Radiology, University of Virginia Health System, Charlottesville, VA.
Rakesh Navuluri, Vascular and Interventional Radiology, Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois, 60637, USA.
Jonathan M. Lorenz, Vascular and Interventional Radiology, Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois, 60637, USA.
Mikin Patel, Vascular and Interventional Radiology, Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois, 60637, USA.

Document Type

Journal Article

Publication Date

4-8-2024

Journal

The British journal of radiology

DOI

10.1093/bjr/tqae074

Keywords

cirrhosis; intravascular ultrasound; portal hypertension; transjugular intrahepatic portosystemic shunt

Abstract

PURPOSE: To conduct a meta-analysis to assess the efficacy of intravascular ultrasound (IVUS) during transjugular intrahepatic portosystemic shunt (TIPS) creation. METHODS: MEDLINE and Embase databases were queried until July 2022 for comparative studies reporting procedure metrics for TIPS creation with or without IVUS guidance. Meta-analysis was performed with random-effects modeling for total procedural time, time to portal venous access, fluoroscopy time, iodinated contrast volume use, air kerma, dose area product, and number of needle passes. Intraoperative procedure-related complications were also reviewed. RESULTS: Of 95 unique records initially identified, 6 were eligible for inclusion. A total of 194 and 240 patients underwent TIPS with and without IVUS guidance. Pooled analyses indicated that IVUS guidance was associated with reduced total procedure time (SMD -0.76 [95% CI -1.02, -0.50] P < 0.001), time to portal venous access (SMD -0.41 [95% CI -0.67, -0.15] P = 0.002), fluoroscopy time (SMD, -0.54 [95% CI -1.02, -0.07]; P = 0.002), contrast volume use (SMD, -0.89 [95% CI -1.16, -0.63]; P < 0.001), air kerma (SMD, -0.75 [95% CI -1.11, -0.38]; P < 0.001) and dose area product (SMD, -0.98 [95% CI -1.77, -0.20]; P = 0.013). 4.2 and 7.8 needle passes were required in the IVUS and non-IVUS group, respectively (SMD, -0.60 [95% CI -1.42, 0.21]; P = 0.134), whereas pooled complication rates were 15.2% (12/79), and 21.4% (28/131), respectively. CONCLUSION: IVUS guidance during TIPS creation improves procedural metrics including procedural time, contrast usage, and radiation exposure.

Department

School of Medicine and Health Sciences Student Works

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