SIR 2024
Portal Hypertension
K. Pallav Kolli, MD, FSIR
Associate Professor of Clinical Radiology
University of California, San Francisco
Disclosure information not submitted.
Bartley Thornburg, MD
Assitant Professor of Radiology
Northwestern University
Disclosure information not submitted.
Dyanna Gregory, MS
Senior Data Analyst and Data Manager
University of Texas Southwestern Medical Center
Disclosure information not submitted.
Justin Boike, MD, MPH
Assistant Professor
Northwestern University
Disclosure information not submitted.
Shamar Young, MD
Associate professor and Chief of Interventional Radiology
University of Arizona
Financial relationships: Full list of relationships is listed on the CME information page.
Michael Fallon, MD
Professor and Chair of Medicine
University of Arizona
Disclosure information not submitted.
Douglas Simonetto, MD
Associate Professor of Medicine
Mayo Clinic
Disclosure information not submitted.
Elizabeth Verna, MD
Associate Professor of Medicine
Columbia University
Disclosure information not submitted.
Lisa VanWagner, MD
Associate Professor of Medicine
UT Southwestern Medical Center
Disclosure information not submitted.
To investigate the use of intracardiac echocardiography (ICE) during transjugular intrahepatic portosystemic shunt (TIPS) placement and understand its effect on outcomes.
Materials and Methods:
This was an IRB approved, HIPAA compliant, multi-center prospective registry study (Advancing Liver Therapeutic Approaches; ALTA) including 587 patients who underwent TIPS placement at 14 centers in the United States between 2019-2023. Age, pre-TIPS MELD, TIPS indication, procedural urgency, performing center, contrast volume, radiation time, number of needle passes, extracapsular passes, and bleeding complications were studied.
Results:
587 patients had TIPS placed at 14 centers. ICE was used in 384 cases (65.4%). Mean age was not different in the ICE (55.7) and non-ICE (58) groups (p=0.22). Pre-TIPS MELD score was higher in the ICE group (12.0) than the non-ICE group (10.9) (p=0.0126). ICE usage was associated with performing center (p < 0.001) and TIPS indication (p=0.0168), but not case urgency (p=0.15). Number of parenchymal needle passes per case was lower in the ICE group (2.2, SD=2.5) compared to the non-ICE group (3.2, SD=2.4) (p=0.0019), and there was a lower number of cases with extracapsular punctures (5 with ICE, 13 without ICE, p< 0.0001). There was no difference in the number of peri-procedural bleeding complications (10 with ICE, 6 without ICE, p=0.73). Mean fluoroscopy time in the ICE group (35.7 min, SD=29.5) and non-ICE group (49.4 min, SD=93.1) trended towards significance (p=0.052). Mean contrast utilization did not differ (ICE = 99.1 mL [SD=52.1] vs non-ICE = 104.3 mL [SD=46.1], p=0.433) after adjusting for outlier data. ICE patients survived a mean of 465 days after TIPS while non-ICE patients survived 613 days. Cox regression analysis for death in ICE vs non-ICE with a competing risk of transplant showed a hazard ratio 1.286 (95% CI: 0.811, 2.039, p=0.2843).
Conclusion:
ALTA TIPS registry analysis reveals that ICE use during TIPS placement is highly center dependent. Across 14 centers in the US that performed 587 TIPS placements, ICE use is also dependent upon pre-TIPS MELD score, which may reflect some operators reserving ICE for the higher risk patients. However, there was no association between the use of ICE and procedural urgency. ICE is associated with a significantly lower number of parenchymal passes, as well as decreased number of extracapsular passes, showing that its use does facilitate portal vein access. This, however, did not translate into decreased peri-procedural bleeding complications or improved survival when using ICE for TIPS placement.