151. Transjugular intrahepatic portosystemic shunt placement: portal vein puncture guided by 3D/2D image registration of contrast-enhanced multi-detector computed tomography and fluoroscopy
- Author
-
Timo C. Meine, Cornelia L. A. Dewald, L. S. Becker, Aline Mähringer-Kunz, Benjamin Massoumy, Sabine K. Maschke, Martha M. Kirstein, Thomas Werncke, Frank K. Wacker, Bernhard C. Meyer, and Jan B. Hinrichs
- Subjects
Radiological and Ultrasound Technology ,Portal Vein ,Urology ,Gastroenterology ,Correction ,Image-guided therapy ,Punctures ,Transjugular intrahepatic portosystemic shunt ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Treatment Outcome ,0302 clinical medicine ,Fluoroscopy ,Hypertension, Portal ,Interventional Radiology ,Operator experience ,Humans ,030211 gastroenterology & hepatology ,Radiology, Nuclear Medicine and imaging ,Portasystemic Shunt, Transjugular Intrahepatic ,Venous intervention ,Image registration - Abstract
Background To assess the technical feasibility, success rate, puncture complications and procedural characteristics of transjugular intrahepatic portosystemic shunt (TIPS) placement using a three-dimensional vascular map (3D-VM) overlay based on image registration of pre-procedural contrast-enhanced (CE) multi-detector computed tomography (MDCT) for portal vein puncture guidance. Materials and methods Overall, 27 consecutive patients (59 ± 9 years, 18male) with portal hypertension undergoing elective TIPS procedure were included. TIPS was guided by CE-MDCT overlay after image registration based on fluoroscopic images. A 3D-VM of the hepatic veins and the portal vein was created based on the pre-procedural CE-MDCT and superimposed on fluoroscopy in real-time. Procedural characteristics as well as hepatic vein catheterization time (HVCT), puncture time (PT), overall procedural time (OPT), fluoroscopy time (FT) and the dose area product (DAP) were evaluated. Thereafter, HVCT, PT, OPT and FT using 3D-VM (61 ± 9 years, 14male) were compared to a previous using classical fluoroscopic guidance (53 ± 9 years, 21male) for two interventional radiologist with less than 3 years of experience in TIPS placement. Results All TIPS procedure using of 3D/2D image registered 3D-VM were successful with a significant reduction of the PSG (p 2. HVCT, OPT and FT of the interventionalist with less TIPS experience using 3D/2D image registered 3D-VM were statistically different to an interventionalist with similar experience using fluoroscopic guidance (pHVCT = 0.0022; pOPT = 0.0097; pFT = 0.0009). PT between these interventionalists was not significantly different (pPT = 0.2905). Conclusion TIPS placement applying registration-based CE-MDCT vessel information for puncture guidance is feasible and safe. It has the potential to improve hepatic vein catherization, portal vein puncture and radiation exposure.
- Published
- 2020