Transjugular intrahepatic portosystemic shunt creation: three-dimensional roadmap versus CO 2 wedged hepatic venography.

Objectives: The blind portal vein puncture remains the most challenging step during transjugular intrahepatic portosystemic shunt (TIPS) creation. We performed a prospective randomised clinical trial to compare three-dimensional (3D) roadmap with CO ₂ wedged hepatic vein portography for portal vein puncture guidance.
Methods: Between March 2017 and May 2017, 30 patients were enrolled and randomly allocated to the study group (3D roadmap) or the control group (CO ₂ wedged hepatic vein portography).
Results: Technical success of TIPS procedures was achieved in all 30 patients. The mean number of needle passes was significantly lower in the study group (2.0 ± 1.0) compared to the control group (3.7 ± 2.5; p = 0.021). A total of six (40%) patients in the study group and three (20%) in the control group required only one puncture for the establishment of TIPS. There were no significant differences in total fluoroscopy time (p = 0.905), total procedure time (p = 0.199) and dose-area product (p = 0.870) between the two groups.
Conclusions: 3D roadmap is a safe and technically feasible means for portal vein puncture guidance during TIPS creation, equivalent in efficacy to CO ₂ wedged hepatic vein portography. This technique could reduce the number of needle passes, thereby simplifying the TIPS procedure.
Key Points: • 3D roadmap can be used to guide portal vein puncture. • Compared with CO ₂ venography, 3D roadmap reduced the number of needle passes. • 3D roadmap has a potential to simplify the TIPS procedure.