Transjugular intrahepatic portosystemic shunt creation using intravascular ultrasound vs fluoroscopic guidance: A dual-institution retrospective comparative study.

Background: The use of intravascular ultrasound (iUS) has been shown in multiple single-center retrospective studies to decrease procedure time, radiation exposure, and needle passes compared to conventional fluoroscopic guidance in the creation of a transjugular intrahepatic portosystemic shunt (TIPS). However, there are few data regarding the impact of imaging guidance modality choice on clinical outcomes.

Objective: To determine the impact of iUS vs fluoroscopic guidance during creation of a TIPS on procedural metrics, liver injury, shunt patency and mortality.

Methods: The retrospective study cohort consisted of 66 patients who underwent TIPS creation using iUS ["iUS-guided TIPS (iTIPS) group"] and 135 patients who underwent TIPS creation using fluoroscopic guidance ["conventional fluoroscopic-guided TIPS (cTIPS) group"] at 2 tertiary academic medical centers from 2015-2019. TIPS that required variceal embolization or portal vein recanalization were excluded.

Results: The technical success rate was 100% in the iTIPS group and 96% in the cTIPS group (P = 0.17). The iTIPS group had an air kerma (266 ± 254 mGy vs 1235 ± 1049 mGy, P < 0.00001), dose area product (5728 ± 6518 uGy × m2 vs 28969 ± 19067 uGy × m2, P < 0.00001), fluoroscopy time (18.7 ± 9.6 minutes vs 32.3 ± 19.0 minutes, P < 0.00001), and total procedure time (93 ± 40 minutes vs 110 ± 51 minutes, P = 0.01) which were significantly lower than the cTIPS group. There was no significant difference in liver function test adverse event grade at 1 month. With a median follow-up of 26 months (inter quartile range: 6-61 months), there was no difference between the two groups in terms of thrombosis-free survival (P = 0.23), intervention-free survival (P = 0.29), or patient mortality (P = 0.61).

Conclusions: The use of iUS in the creation of TIPS reduces radiation exposure and procedure time compared with fluoroscopic guidance. At midterm follow-up, the imaging guidance modality did not affect shunt patency or mortality.