Advantages of Intracardiac Echocardiography for TIPS Creation: a Propensity Score–Matched Study from a Single Institution Experience

To evaluate the outcomes following transjugular intrahepatic portosystemic shunt (TIPS) creation with intracardiac echocardiography (iTIPS) versus conventional TIPS (cTIPS).

Materials and Methods:

A retrospective review of 343 patients who underwent a TIPS procedure between February 2010 and May 2024 was performed. Patients who underwent iTIPS (n=37) and cTIPS (n=306) were propensity score matched (PSM) using the following covariates: age, sex, alanine and aspartate aminotransferase, albumin, and total bilirubin. Student’s t-test was performed for numerical variables and chi-squared or Fisher Exact tests for categorical variables. Adverse events (AEs) were classified according to SIR criteria.

Results:

Following PSM there were 37 patients identified from both cTIPS and iTIPS groups, all covariates were well-matched and well-balanced with P > .111. There were 22 males and 15 females in the cTIPS cohort and 27 males and 10 females in the iTIPS  cohort (P = .219). The mean age was 59.2 ± 8.7 for cTIPS and 56.3 ± 12.1 for iTIPS (P = .238) and mean BMI was 26.7 ± 4.9 for cTIPS and 27.2 ± 5.3 for iTIPS (P = .688). Indications for TIPS included bleeding, refractory ascites, and hepatic hydrothorax, which were well-matched between cohorts (P = .962). Technical success occurred in 100% and 97.3% of patients following cTIPS and iTIPS, respectively (P = .314). There were significantly more AEs following cTIPS (7 AE cTIPS, 1 AE iTIPS; P = .025). In the cTIPS cohort, there were 5 AEs that were mild (4 elevated aminotransferases, 1 hemoglobin decrease), 1 moderate (hemoperitoneum requiring blood products), and 1 severe (intrabdominal hemorrhage resulting in death). There was 1 moderate AE following iTIPS, which was a liver hematoma requiring coil embolization of the anterior division of the right hepatic artery. Hospital length of stay was significantly shorter following iTIPS (3.2 versus 4.9 days, P = .030). Fluoroscopy time was shorter with a trend toward significance (iTIPS 31.2 minutes, cTIPS 40.2 minutes; P = 0.053). All cause 30-day mortality was 13.5% following cTIPS and 8.1% following iTIPS (P = 0.336).

Conclusion:

In this propensity score matched, single center study, intracardiac echocardiography resulted in significantly less AEs and a shorter hospital length of stay following TIPS creation.