014 - Using Intravascular Ultrasound in the Creation of Transjugular Intrahepatic Portosystemic Shunts (TIPS): A Meta-analysis
ashwin Deshmukh, M.D. – Resident, Yale Newhaven/Bridgeport Hospital; Gaurav Parmar, M.D. – Resident, Yale Newhaven/Bridgeport Hospital; Scott Jafarian, M.D. – Resident, Yale Newhaven/Bridgeport Hospital; Juan Carlos Perez Lozada, M.D. – Associate Professor, Yale school of Medicine; angelo Marino, DO – Assistant Professor, Yale school of Medicine; Todd Schlachter, M.D. – Professor, Yale School of Medicine
Purpose: We performed a systematic review and meta-analysis to assess the benefit of intravascular ultrasound (IVUS)–guided portal vein access during transjugular intrahepatic portosystemic shunt (TIPS) creation in comparison to the conventional TIPS technique.
Material and Methods: This meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A search of databases was conducted by two researchers independently through September, 2021. Outcomes of interest included transjugular intrahepatic portosystemic shunt, intravascular ultrasound (US)–guided portal vein access, fluoroscopy time, radiation exposure, procedure time, portal access time, and complications. A random effects model meta-analysis was performed.
Results: Six clinical trials met our inclusion criteria for meta-analysis. 418 patients (258 males and 159 females) were included in the final dataset, with 180 undergoing IVUS-guided TIPS creation (iTIPS) and 238 patients undergoing conventional TIPS creation (cTIPS). There was a significant decrease in fluoroscopy time in the iTIPS group in comparison to the cTIPS group by 9.74 minutes (95% CI: 17.52-1.96, p< 0.001) and, subsequently, a significant decrease in radiation exposure (air kerma) in the iTIPS group by 583.4 (mGy) (95% CI: 923.6-243.2, p< 0.001). The total procedure time and portal venous (PV) access time significantly decreased when using IVUS in comparison with cTIPS by 21 minutes (95% CI: 39.5-2.2, p< 0.001), and by 15.49 minutes (95% CI: 23.6-7.1, p< 0.001) respectively. Additionally, the volume of contrast agent used during the procedure significantly decreased in iTIPS group in comparison to cTIPS group by 69.62 cc (95% CI: 35.58-103.66, p< 0.001).
Conclusions: Present meta-analysis revealed that when compared to the standard TIPS technique, intravascular IVUS resulted in a significant reduction in fluoroscopy time, air kerma, procedure time, and volume of contrast agent. These findings advocate for a broader use of IVUS for TIPS creation, particularly in complex and radiosensitive patient populations.