Advantages of intravascular ultrasound guidance for TIPS: Systematic review of the literature and a single institution propensity score-matched study.

PURPOSE: Systematically review safety and efficacy of intravascular ultrasound (IVUS)-guided transjugular intrahepatic portosystemic shunt (TIPS) (iTIPS) and to evaluate outcomes following conventional TIPS (cTIPS) versus iTIPS in propensity score-matched patients.

MATERIALS AND

METHODS

"Intravascular ultrasound," "transjugular intrahepatic portosystemic shunt," "intracardiac echocardiography" were used to query PubMed through November 2024. Patients who underwent TIPS at this institution April 2016-August 2024 were included in the meta-analysis and compared in an unmatched and propensity score-matched analysis.

RESULTS

Unmatched analysis included 41 iTIPS and 124 cTIPS (55.2 ± 11.7 years, 79 males (cTIPS), 56.6 ± 11.7 years, 27 males (iTIPS)). Technical success was 94.4 % (cTIPS) and 97.6 % (iTIPS). Fluoroscopy time (P = .007) and hospital length of stay (LOS) (P = .0003) were longer with cTIPS. Ten and two procedure-related adverse events occurred following cTIPS and iTIPS, respectively. Propensity score-matching produced 40 iTIPS and cTIPS cases each (26 males each, age 57.6 ± 11.5 years (cTIPS) and 56.3 ± 11.7 years (iTIPS)). Technical success was 98 % for both. Hospital LOS was longer following cTIPS (P < .0001). Two procedure-related adverse events occurred following both cTIPS and iTIPS. Seven reports were included, totaling 8 studies (517 cTIPS, 379 iTIPS). Mean age was 56 years (iTIPS) and 55 years (cTIPS) and there were 60:40 males:females in both cohorts. Fluoroscopy time (P = .0006), procedure time (P < .00001), portal vein access time (P = .0003), contrast volume (P < .00001), hepatic needle passes (P < .0001), and adverse events (P = .005), specifically extracapsular puncture/hemoperitoneum, were reduced with iTIPS.

CONCLUSION

iTIPS has the potential to reduce procedure time, radiation exposure, hepatic needle passes, contrast volume, hospital LOS and complication rates.