605 - Navigating the Liver: A Comparative Study of Trans Jugular Intrahepatic Portal Shunt (TIPS) Techniques

Monday, April 13, 2026

12:10 PM - 1:10 PM ET

Poster Presenter(s)

Jasmine Lee (she/her/hers)

Medical Student
Rutgers New Jersey Medical School, United States

Author/Co-author(s)

IE

Ipek Eralp, MS

Medical Student
Rutgers Robert Wood Johnson Medical School, United States
SR

Shayan Rashid, MD

Clinical Assistant Professor
Rutgers Robert Wood Johnson Medical School, United States
MC

Michael Censullo, MD

Clinical Professor
Rutgers Robert Wood Johnson Medical School, United States
IL

Ilya Livshits, MD

Attending Physician
Robert Wood Johnson University Hospital, United States
SB

Sumit Baral, MD

Attending Physician
Robert Wood Johnson University Hospital, United States
Ali Saifuddin, MD

Resident
Rutgers, Robert Wood Johnson Medical School, United States
AL

Albert Li, MD

Attending Physician
Rutgers Robert Wood Johnson Medical School, United States
JK

Joshua Kornblum, DO

Resident physician
Robert Wood Johnson University Hospital, United States
IM

Issam Moubarak, MD

Clinical Associate Professor
Rutgers Robert Wood Johnson Medical School, United States
AK

Aleksander Kubiak, MD

Attending Physician
Robert Wood Johnson University Hospital, United States
FK

Francis Kang, MD

Attending Physician
Rutgers Robert Wood Johnson Medical School, United States

Purpose: To compare the procedure characteristics, patient outcomes, and complication rates when TIPS is performed with intracardiac echocardiography vs. conventional fluoroscopy vs. complex techniques.

Materials and Methods: A retrospective single center study with 61 TIPS procedures using conventional techniques, ICE guidance, or complex approaches, including direct percutaneous transhepatic or transplenic access, was performed from January 2020 to July 2025. Procedure characteristics included: pre and post-TIPS portosystemic gradients, fluoroscopy time, procedure time, number of puncture attempts to access the portal system, and technical success. Complications, such as bleeding, pseudoaneurysm, and death were also collected.

Results: Of the 61 TIPS procedures, 37 patients (61%) were male and 24 (39%) were female. Conventional fluoroscopy was used in 30 procedures (49%), intracardiac echocardiography (ICE) in 25 (41%), and 6 procedures (10%) were classified as complex TIPS, requiring additional direct percutaneous transhepatic or transplenic access; only one of the complex cases used ICE.

Procedure times differed significantly among the three groups, F(2,61)=4.65, p=.014. Post hoc comparisons indicated that complex TIPS procedures had longer procedure times (151 ± 36.4 min) than both ICE (98.5 ± 47.8 min, p=.011) and conventional TIPS (92.9 ± 38.5 min, p=.024). However, procedure times did not differ between ICE and conventional TIPS (p=.885).

Interestingly, there was a significant difference in the number of puncture attempts across groups, H(2)=11.96, p =.003. ICE TIPS required fewer puncture attempts than both conventional TIPS (p =.003) and complex TIPS (p =.012). No significant differences were observed among groups for complication rate (p=.317) or technical success (H(2)=0.52, p=.770).

Conclusion: The use of ICE guidance during TIPS procedures resulted in significantly reduced puncture attempts when compared to the use of conventional fluoroscopic techniques and complex TIPS cases. However, there was no difference in post-operative complication rates or technical success. These findings highlight potential benefits of ICE-guided TIPS, warranting future prospective, powered studies.