SIR 2024
Portal Hypertension
Christine Yoon (she/her/hers)
MS3
Albert Einstein College of Medicine
Financial relationships: Full list of relationships is listed on the CME information page.
Darnell A. Williams, BS
MSTP Candidate
Albert Einstein College of Medicine
Disclosure information not submitted.
Paul M. Armenta, MD
Integrated Interventional Radiology Resident PGY-5
Montefiore Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
Jacob Cynamon, MD, FACR, FSIR
Section Chief of Interventional Radiology
Montefiore Medical Center
Disclosure information not submitted.
Kapil Wattamwar, MD
Interventional Radiology Fellow
Montefiore Medical Center
Disclosure information not submitted.
While several anatomic and technical factors are known to predispose to Transjugular Intrahepatic Portosystemic Shunts (TIPS) thrombosis, we hypothesize that geometric factors of TIPS stents, including curvature, are also implicated in thrombosis {1-3}. We introduce a novel web-based tool designed to measure the curvature of TIPS stents and explore its potential to predict future thrombosis. Single institution radiological records of all patients who underwent TIPS placement from 1/1/2015 through 9/10/2022 were reviewed. Patients requiring reintervention for TIPS thrombosis within 1 year of placement were identified. Fluoroscopic images demonstrating TIPS position in the anteroposterior view were collected for analysis. An interactive web tool was created to enable users to mark three critical points along the endoprostheses: the vertex, proximal end, and distal end. A curve was mapped to these points using a horizontal parabola of best fit and the associated quadratic formula was calculated. The algorithm extracted the first derivative at the vertex (indicating rate of change), the second derivative (reflecting curvature), and coefficients of the quadratic formula. A total of 238 TIPS were performed at a single institution within the given time period. There was a 95% one-year patency rate with 13 endoprostheses becoming thrombosed and requiring reintervention. Mean curvature with standard error was 0.023±0.0063 for patent TIPS and 0.096±0.037 for thrombosed TIPS. Unpaired t-test revealed that thrombosed TIPS had significantly greater mean curvature (p=0.0086) by a difference of 0.073 (95% CI 0.019, 0.13). First derivative at the vertex was also significantly different, noted to be positive and more pronounced in thrombosed TIPS (1.634 vs -0.754, p< 0.0001). Findings using this web-tool support the hypothesis that greater TIPS curvature is associated with thrombosis within one year. Subsequent research on TIPS patency will include other factors such as stent diameter and length, portal and systemic pressures, and timeline and degree of thrombosis. Future work will also focus on implementing more complex and three-dimensional curve-fitting models and automating detection with AI. The web tool may also contribute to research in other areas of radiology where geometry bears relevance to outcomes. Interested stakeholders are encouraged to trial the tool, with preliminary results obtainable in under 10 seconds for a given TIPS endoprosthesis.
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