Xuefeng Luo1,2, Linchao Ye3, Xuan Zhou1, Jiaywei Tsauo1,2, Biao Zhou1,2, Hailong Zhang1,2, Xiaowu Zhang1, Xiao Li4,5. 1. Center of Interventional Radiology, West China Hospital, Sichuan University, 37# Guoxue Lane, Chengdu, 610041, Sichuan, China. 2. Department of Gastroenterology, West China Hospital, Sichuan University, 37# Guoxue Lane, Chengdu, 610041, Sichuan, China. 3. Angiography Business Unit, Healthcare Sector, Siemens Limited China, Shanghai, China. 4. Center of Interventional Radiology, West China Hospital, Sichuan University, 37# Guoxue Lane, Chengdu, 610041, Sichuan, China. simonlixiao@126.com. 5. Department of Gastroenterology, West China Hospital, Sichuan University, 37# Guoxue Lane, Chengdu, 610041, Sichuan, China. simonlixiao@126.com.
Abstract
PURPOSE: The purpose of this study was to compare two-dimensional digital subtraction angiography (2D-DSA) with C-arm cone-beam volume computed tomography (CACT) in the evaluation of portal vein entry and shunt course during transjugular intrahepatic portosystemic shunt (TIPS) procedure. MATERIALS AND METHODS: Between May 2010 and November 2011, 21 patients who underwent direct portography in anteroposterior and lateral projections and subsequent CACT before stent placement during TIPS creation were reviewed retrospectively. CACT images were examined for evaluation of the portal vein entry and shunt course in comparison to 2D-DSA images by two experienced interventional radiologists. RESULTS: CACT was proven to be better than 2D-DSA in identification of the portal vein entry (P < 0.001) and intra- or extrahepatic puncture (P < 0.001). No significant difference was observed in evaluating the shunt course (P = 0.086). The portal vein entry was considered inappropriate in seven (33%) out of 21 patients; among them, four cases were due to extrahepatic puncture, and three cases were due to peripheral puncture of the portal vein which may result in stent kinking. CONCLUSION: While 2D-DSA remains the standard imaging method to evaluate portal vein entry, shunt course, and portal vein anatomy during TIPS procedure, CACT can effectively identify the portal vein entry and assess shunt course in difficult cases intra-procedurally, hence may reduce the risk of potential life-threatening intra-abdominal hemorrhage and shunt dysfunction.
PURPOSE: The purpose of this study was to compare two-dimensional digital subtraction angiography (2D-DSA) with C-arm cone-beam volume computed tomography (CACT) in the evaluation of portal vein entry and shunt course during transjugular intrahepatic portosystemic shunt (TIPS) procedure. MATERIALS AND METHODS: Between May 2010 and November 2011, 21 patients who underwent direct portography in anteroposterior and lateral projections and subsequent CACT before stent placement during TIPS creation were reviewed retrospectively. CACT images were examined for evaluation of the portal vein entry and shunt course in comparison to 2D-DSA images by two experienced interventional radiologists. RESULTS: CACT was proven to be better than 2D-DSA in identification of the portal vein entry (P < 0.001) and intra- or extrahepatic puncture (P < 0.001). No significant difference was observed in evaluating the shunt course (P = 0.086). The portal vein entry was considered inappropriate in seven (33%) out of 21 patients; among them, four cases were due to extrahepatic puncture, and three cases were due to peripheral puncture of the portal vein which may result in stent kinking. CONCLUSION: While 2D-DSA remains the standard imaging method to evaluate portal vein entry, shunt course, and portal vein anatomy during TIPS procedure, CACT can effectively identify the portal vein entry and assess shunt course in difficult cases intra-procedurally, hence may reduce the risk of potential life-threatening intra-abdominal hemorrhage and shunt dysfunction.