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Three-dimensional Image Fusion Guidance for Transjugular Intrahepatic Portosystemic Shunt Placement

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Abstract

Introduction

To assess the safety, feasibility and effectiveness of image fusion guidance with pre-procedural portal phase computed tomography with intraprocedural fluoroscopy for transjugular intrahepatic portosystemic shunt (TIPS) placement.

Materials and methods

All consecutive cirrhotic patients presenting at our interventional unit for TIPS creation from January 2015 to January 2016 were prospectively enrolled. Procedures were performed under general anesthesia in an interventional suite equipped with flat panel detector, cone-beam computed tomography (CBCT) and image fusion technique. All TIPSs were placed under image fusion guidance. After hepatic vein catheterization, an unenhanced CBCT acquisition was performed and co-registered with the pre-procedural portal phase CT images. A virtual path between hepatic vein and portal branch was made using the virtual needle path trajectory software. Subsequently, the 3D virtual path was overlaid on 2D fluoroscopy for guidance during portal branch cannulation. Safety, feasibility, effectiveness and per-procedural data were evaluated.

Results

Sixteen patients (12 males; median age 56 years) were included. Procedures were technically feasible in 15 of the 16 patients (94%). One procedure was aborted due to hepatic vein catheterization failure related to severe liver distortion. No periprocedural complications occurred within 48 h of the procedure. The median dose-area product was 91 Gy cm2, fluoroscopy time 15 min, procedure time 40 min and contrast media consumption 65 mL. Clinical benefit of the TIPS placement was observed in nine patients (56%).

Conclusion

This study suggests that 3D image fusion guidance for TIPS is feasible, safe and effective. By identifying virtual needle path, CBCT enables real-time multiplanar guidance and may facilitate TIPS placement.

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Acknowledgements

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Assistance Publique – Hôpitaux de Paris (AP-HP), Service d’Imagerie Médicale, CHU Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, Créteil, 94010, France

    Vania Tacher, Arthur Petit, Haytham Derbel, Luigi Novelli, Manuel Vitellius, Fourat Ridouani, Alain Luciani, Alain Rahmouni, Mélanie Chiaradia & Hicham Kobeiter

  2. Institut Mondor de Recherche Biomédicale, Inserm U955 équipe n°18, Créteil, France

    Vania Tacher & Alain Luciani

  3. Université Paris-Est Créteil (UPEC), Créteil, 94010, France

    Vania Tacher, Alain Luciani, Alain Rahmouni, Christophe Duvoux & Hicham Kobeiter

  4. Assistance Publique – Hôpitaux de Paris (AP-HP), Service d’Hépatologie, CHU Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, Créteil, 94010, France

    Christophe Duvoux

  5. Assistance Publique – Hôpitaux de Paris (AP-HP), Service de Chirurgie Digestive, CHU Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, Créteil, 94010, France

    Chady Salloum

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  1. Vania Tacher
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  2. Arthur Petit
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Correspondence to Vania Tacher.

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Tacher, V., Petit, A., Derbel, H. et al. Three-dimensional Image Fusion Guidance for Transjugular Intrahepatic Portosystemic Shunt Placement. Cardiovasc Intervent Radiol 40, 1732–1739 (2017). https://doi.org/10.1007/s00270-017-1699-9

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  • DOI: https://doi.org/10.1007/s00270-017-1699-9

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