Meta-analysis of Transjugular Intrahepatic Portosystemic Shunt Creation with Intravascular Ultrasound Guidance

Monday, March 6, 2023

12:00 PM – 1:00 PM

Location: Phoenix Convention Center, North Ballroom 120 D

Poster Presenter(s)

Qian Yu, MD (he/him/his)

Resident
University of Chicago

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

Osman Ahmed, MD, FSIR

Associate Professor of Radiology
University of Chicago
Subhash Gutti, BA (he/him/his)

Medical Student
George Washington University School of Medicine
Deepak Iyer, MD (he/him/his)

Resident Physician
Icahn School of Medicine at Mount Sinai
J. Fritz F. Angle, MD

Director of Interventional Radiology
Department of Radiology and Medical Imaging, University of Virginia
Rakesh C. Navuluri, MD, FSIR

Associate Professor
University of Chicago
JL

Jonathan Lorenz, MD, FSIR

Professor of Radiology
The University of Chicago
ES

Emily Sellers, MD

Resident
University of Chicago
SA

Syed Ahmed, BS

Medical Student
Midwestern University Chicago College of Osteopathic Medicine
AS

Adam Said, BS

Student
UIUC
Waseem Wahood, MS

Medical Student
Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University
MP

Mikin Patel, MD

Assistant Professor
University of Chicago

Disclosure(s):

Qian Yu, MD: No financial relationships to disclose

Osman Ahmed, MD, FSIR: Argon Medical: Advisory Committee or Review Panel Member (Ongoing); Asahi: Consultant (Ongoing); Bard Peripheral Vascular: Speaking and Teaching (Terminated, September 1, 2022); Boston Scientific: Advisory Committee or Review Panel Member (Ongoing), Consultant (Ongoing); Canon Medical Systems: Consultant (Ongoing), Contracted Research (Ongoing); Cook: Speaking and Teaching (Ongoing); Johnson & Johnson: Advisory Committee or Review Panel Member (Ongoing); Penumbra Inc.: Speaking and Teaching (Ongoing); Philips: Contracted Research (Terminated, October 1, 2022)

Subhash Gutti, BA: No financial relationships to disclose

Deepak Iyer, MD: No financial relationships to disclose

J. Fritz F. Angle, MD: No relevant disclosure to display

Jonathan Lorenz, MD, FSIR: No financial relationships to disclose

Waseem Wahood, MS: No financial relationships to disclose

Purpose: To conduct a meta-analysis to assess the efficacy of intravascular ultrasound (IVUS) during transjugular intrahepatic portosystemic shunt (TIPS) creation.

Materials and Methods:

: MEDLINE and Embase databases were queried until July 2022 for comparative studies reporting procedure metrics for TIPS creation with or without IVUS guidance. Meta-analysis was performed with random-effects modeling for total procedural time, time to portal venous access, fluoroscopy time, iodinated contrast volume use, air kerma, dose area product, and number of needle passes. Intraoperative procedure-related complications were also reviewed.

Results:

Of 95 unique records initially identified, 6 were eligible for inclusion. A total of 194 and 240 patients underwent TIPS with and without IVUS guidance. Pooled analyses indicated that IVUS guidance was associated with reduced total procedure time (SMD -0.76 [95% CI -1.02, -0.50] P < 0.001), time to portal venous access (SMD -0.41 [95% CI -0.67, -0.15] P = 0.002), fluoroscopy time (SMD, -0.54 [95% CI -1.02, -0.07]; P = 0.002), contrast volume use (SMD, -0.89 [95% CI -1.16, -0.63]; P < 0.001), air kerma (SMD, -0.75 [95% CI -1.11, -0.38]; P < 0.001) and dose area product (SMD, -0.98 [95% CI -1.77, -0.20]; P = 0.013). 4.2 and 7.8 needle passes were required in the IVUS and non-IVUS group, respectively (SMD, -0.60 [95% CI -1.42, 0.21]; P = 0.134), whereas pooled complication rates were 15.2% (12/79), and 21.4 % (28/131), respectively.

Conclusion:

IVUS guidance during TIPS creation improves procedural metrics including procedural time, contrast usage, and radiation exposure.