Meta-analysis of transjugular intrahepatic portosystemic shunt creation with or without intravascular ultrasound guidance

Qian Yu, Vascular and Interventional Radiology, Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, IL 60637, United States.
Osman Ahmed, Vascular and Interventional Radiology, Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, IL 60637, United States.
Subhash Gutti, School of Medicine and Health Sciences, The George Washington University, Washington, DC, 20007, United States.
Deepak Iyer, School of Medicine and Health Sciences, The George Washington University, Washington, DC, 20007, United States.
Daniel Kwak, Vascular and Interventional Radiology, Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, IL 60637, United States.
Syed Samaduddin Ahmed, College of Osteopathic Medicine, Midwestern University Chicago, Chicago, IL, 60515, United States.
Adam Said, University of Illinois at Urbana-Champaign, Champaign, IL, 61820, United States.
J Fritz Angle, Vascular and Interventional Radiology, University of Virginia Health System, Charlottesville, VA, United States.
Rakesh Navuluri, Vascular and Interventional Radiology, Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, IL 60637, United States.
Jonathan M. Lorenz, Vascular and Interventional Radiology, Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, IL 60637, United States.
Mikin Patel, Vascular and Interventional Radiology, Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, IL 60637, United States.

Document Type

Journal Article

Publication Date

5-29-2024

Journal

The British journal of radiology

Volume

97

Issue

1158

DOI

10.1093/bjr/tqae074

Keywords

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

Abstract

OBJECTIVE: 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 modelling 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 < .001), time to portal venous access (SMD -0.41 [95% CI -0.67, -0.15] P = .002), fluoroscopy time (SMD, -0.54 [95% CI -1.02, -0.07]; P = .002), contrast volume use (SMD, -0.89 [95% CI -1.16, -0.63]; P < .001), air kerma (SMD, -0.75 [95% CI -1.11, -0.38]; P < .001) and dose area product (SMD, -0.98 [95% CI -1.77, -0.20]; P = .013). A total of 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 = .134). 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. ADVANCES IN KNOWLEDGE: (1) The use of IVUS during TIPS is associated with shorter procedural time, lower contrast usage, and radiation exposure. (2)The use of IVUS is not associated with higher complication rates.

Department

School of Medicine and Health Sciences Student Works

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