Karim Rouabah, Presenter: Nothing to Disclose

Jean-Marie Caporossi, Abstract Co-Author: Nothing to Disclose

Guillaume Louis MD, Abstract Co-Author: Nothing to Disclose

Alexis Jacquier MD, Abstract Co-Author: Research Grant, Groupe DANONE SA Research Grant, Merck & Co, Inc Consultant; General Electric Company Travel support, Siemens AG Travel support, Boston Scientific Corporation

Jean-Michel Bartoli MD, Abstract Co-Author: Nothing to Disclose

Vincent Vidal MD, Abstract Co-Author: Nothing to Disclose

Evaluate the feasibility, accuracy and safety of Image-Fusion using 3D portography from pre-procedural Computed Tomography Angiography (CTA) with the fluoroscopy in portal vein puncture during TIPS.

Eighteen patients underwent TIPS with Image-Fusion from pre-procedural CTA. The wedged iodinated sus hepatic vein portography was the conventional method used to visualize the portal vein. The study was performed by two groups of operators: one composed of radiologist with less than 3 years experience in TIPS procedure and the other more experienced. A direct portography was performed after succesful portal vein puncture to analyze the accuracy of the Image-Fusion. The subjective utility of the image fusion for the portal puncture and the pre-procedural CTA post-processing time were analyzed. We also studied the total number of puncture attempts, the global radiation exposure as well as the specific radiation exposure correlated to the wedged sus-hepatic portography.  

The TIPS procedure was succesful in 17 patients (94.4 %). The image fusion was useful in 13 patients (72.2%). The average post-processing time was 16.4 minutes. Image fusion was strictly superimposed with the direct portography in 10 patients (55.6%). The average gap was 0.69 cm in height and 0.28 cm laterally. The mean number of puncture was 4.6. Eight patients needed less than 3 portal vein puncture attempts. The wedged sus hepatic portography was interpretable in 8 patients (44.4 %), its mean radiation exposure was 421.2 dGy.cm² corresponding to an average surexposure of 19%. No complication was noticed.

Image fusion from pre-procedural CTA whit fluoroscopy in portal vein puncture during TIPS is a promising, feasible, safe and accurate technique. 

Long-term survival and post-procedures complications of TIPS are related to good initial positioning of the stent, depending on the precision of the portal puncture.

Rouabah, K, Caporossi, J, Louis, G, Jacquier, A, Bartoli, J, Vidal, V, Approach of Image-Fusion from Pre-procedural Computed Tomography Angiography in an Interventional Vascular Procedure: The Portal Vein Puncture during Transjugular Intrahepatic Portosystemic Shunt (TIPS).  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14015261.html