Xuefeng Luo1,2, Xiaoze Wang2, Jiaze Yu2, Yongjun Zhu1, Xiaotan Xi1, Huaiyuan Ma2, Li Yang3. 1. Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, People's Republic of China. 2. Department of Interventional Radiology, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, People's Republic of China. 3. Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, People's Republic of China. yangli_hx@scu.edu.cn.
Abstract
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 CO2 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 (CO2 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 CO2 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.
RCT Entities:
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 CO2 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 (CO2 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 CO2 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.
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