Feasibility and Effectiveness of Hepatic Artery Guiding Technique in Transjugular Intrahepatic Portosystemic Shunt Procedure

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Background: Puncture from the hepatic vein to the portal vein to create a shunt is the most challenging step in transjugular intrahepatic portosystemic shunt (TIPS) procedure Objectives: To evaluate the feasibility and effectiveness of the hepatic artery guiding technique in TIPS procedure. Patients and Methods: From January 2009 to December 2018, 41 patients (36 men, five women; mean age, 57.9 years; range, 33 - 77 years) who underwent TIPS were retrospectively evaluated. Total procedure times, puncture times, and total procedure radiation doses as radiation quantity (mGy) and dose area product (μGym2) from each procedure were compared using the Mann-Whitney U test between those in the simple blind puncture group and those who underwent hepatic artery guiding technique. Results: Technical success was achieved in all patients. Out of 41 patients, simple blind puncture was performed in 11 patients (26.8%), and hepatic artery guiding technique was performed in 30 patients (73.2%). No complications were observed in either group. The mean puncture time among those who underwent hepatic artery guiding technique (26.67 ± 11.46 min) was significantly shorter than the mean puncture time in the simple blind puncture group (38.50 ± 29.69 min) (P = 0.045). There was no statistical significance in total procedure time and radiation dose (P > 0.05). Conclusion: Hepatic artery guiding technique could increase the feasibility of portal vein puncture in TIPS without a significant increase in radiation dose.