Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 28, 2015; 21(32): 9623-9629
Published online Aug 28, 2015. doi: 10.3748/wjg.v21.i32.9623
Contrast enhanced computed tomography and reconstruction of hepatic vascular system for transjugular intrahepatic portal systemic shunt puncture path planning
Jian-Ping Qin, Shan-Hong Tang, Ming-De Jiang, Qian-Wen He, Hong-Bin Chen, Xin Yao, Wei-Zheng Zeng, Ming Gu
Jian-Ping Qin, Shan-Hong Tang, Ming-De Jiang, Hong-Bin Chen, Xin Yao, Wei-Zheng Zeng, Department of Digestion, General Hospital of Chengdu Military Command, Chengdu 610083, Sichuan Province, China
Shan-Hong Tang, Disease Preventive and Control Center, Chengdu Military Command, Chengdu 610000, Sichuan Province, China
Qian-Wen He, Ming Gu, Department of Radiology, General Hospital of Chengdu Military Command, Chengdu 610083, Sichuan Province, China
Author contributions: Qin JP performed the surgical procedures, wrote the paper and analyzed the data; Tang SH collected the data and wrote the paper; Jiang MD provided clinical treatments, analyzed the data and revised the paper; He QW performed the surgical procedures and reconstructed three-dimensional images; Chen HB and Yao X participated in surgical operation and collected the data; Zeng WZ managed the patients, collected the data and revised the paper; Gu M performed the surgical procedures and reconstructed three-dimensional images; Qin JP and Tang SH contributed equally to this work.
Supported by General Hospital of Chengdu Military Command, No. 2013YG-B009.
Institutional review board statement: The study was reviewed and approved by the General Hospital of Chengdu Military Command Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors declare that they have no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jian-Ping Qin, MD, Department of Digestion, General Hospital of Chengdu Military Command, 273 Rongdu Road, Chengdu 610083, Sichuan Province, China. jianpingqin@yeah.net
Telephone: +86-28-86570705
Received: February 11, 2015
Peer-review started: February 11, 2015
First decision: March 26, 2015
Revised: April 20, 2015
Accepted: June 9, 2015
Article in press: June 10, 2015
Published online: August 28, 2015
Abstract

AIM: To describe a method for the transjugular intrahepatic portal systemic shunt (TIPS) placement performed with the aid of contrast-enhanced computed tomography (CECT) and three-dimensional reconstructed vascular images (3D RVIs), and to assess its safety and effectiveness.

METHODS: Four hundred and ninety patients were treated with TIPS between January 2005 and December 2012. All patients underwent liver CECT and reconstruction of 3D RVIs of the right hepatic vein to portal vein (PV) prior to the operation. The 3D RVIs were carefully reviewed to plan the puncture path from the start to target points for needle pass through the PV in the TIPS procedure.

RESULTS: The improved TIPS procedure was successful in 483 (98.6%) of the 490 patients. The number of punctures attempted was one in 294 (60%) patients, 2 to 3 in 147 (30%) patients, 4 to 6 in 25 (5.1%) patients and more than 6 in 17 (3.5%) patients. Seven patients failed. Of the 490 patients, 12 had punctures into the artery, 15 into the bile duct, eight into the gallbladder, and 18 through the liver capsule. Analysis of the portograms from the 483 successful cases indicated that the puncture points were all located distally to the PV bifurcation on anteroposterior images, while the points were located proximally to the bifurcation in the three cases with intraabdominal bleeding. The complications included three cases of bleeding, of whom one died and two needed surgery.

CONCLUSION: Use of CECT and 3D RVIs to plan the puncture path for TIPS procedure is safe, simple and effective for clinical use.

Keywords: Transjugular intrahepatic portal systemic shunt, Contrast-enhanced computed tomography, 3D vascular reconstruction, Interventional radiology

Core tip: Precise planning of puncture path is crucial for safe and effective transjugular intrahepatic portal systemic shunt (TIPS) placement. We have developed and applied an approach that combines contrast-enhanced computed tomography and reconstruction of hepatic vascular system in TIPS placement. Our retrospective study with 490 patients over a period of seven years shows that the improved TIPS procedure was successful in 98.6% of the patients, indicating that this method is safe, simple and effective for clinical use.