Optimal guiding methods for transjugular intrahepatic portosystemic shunt creation: Characteristics of intravascular ultrasound vs other techniques

Table 1 Comparison between intravascular ultrasound and other techniques

Technique	Safety/efficacy (metrics)	Cost/resources	Learning curve	Availability/adoption	Ref.
Fluoroscopic (conventional)	Technical success: 95–100%; number of punctures: 5-6 times or more; radiation dose: High (over 30 minutes fluoroscopy); complication rate: Relatively higher (5%-30%)	Low capital cost–uses standard angio suite and catheters; no special disposables	Well-established; standard IR training applies	Universal (standard practice in all centers)	Partovi et al[6], Farsad et al[10], Kao et al[11]
3D image fusion (CBCT/angio-CT)	Technical success: Virtually 100%; number of punctures: 4-5 times on average; radiation dose: Relatively lower; complications rate: Relatively lower (0%-5%)	Very high capital equipment (hybrid angio-CT or advanced Carm with CBCT; minimal extra disposables beyond baseline	Moderate–steep: Operator must learn new 3D overlay/navigation tools	Limited to centers with hybrid angio-CT or CBCT capability (growing in major hospitals)	Nadjiri et al[7], Rouabah et al[8]
Electromagnetic navigation	Technical success: Animal studies showed 62% success (5/8 pigs) with a learning curve; number of punctures: None on humans; radiation dose: Low (approximately 15 minutes fluoroscopy); complications rate: No puncture complications reported in limited series	Prototype devices; requires special electromagnetic-transmitter and instrumented needle; likely expensive developmental equipment	Steep: Systems are experimental. Operators require training in electromagnetic tracking use	Not commercially available for transjugular intrahepatic portosystemic shunt; limited to research settings	Isfort et al[9]
IVUS	Technical success: Virtually 100%; number of punctures: 2 times on average; radiation dose: Relatively lower; complications rate: Relatively lower (0%-15%)	Requires IVUS console ($30–100K+) and single-use IVUS probes (approximately $2100 each); disposable cost is substantial amortization and maintenance also factors	Moderate: Operators need ultrasound skills, but some IRs use IVUS in other contexts. Trainee availability is variable	Commercially available (e.g., from Philips, Siemens); adoption growing in tertiary centers, but not yet universal	Farsad et al[10], Kao et al[11], Triana et al[13]

CBCT: Cone beam computed tomography; CT: Computed tomography; IR: Interventional radiology; IVUS: Intravascular ultrasound; 3D: Three-dimensional.