Abstract No. 281 Characterizing the Learning Curve of Adopting Intracardiac Echo Guidance in Creation of Transjugular Intrahepatic Portosystemic Shunts

To characterize the learning curve of implementing intracardiac echo (ICE) to guide portal vein (PV) access during transjugular intrahepatic portosystemic shunt (TIPS) creation. An institutional review board–approved retrospective review of all TIPS creations performed between 7/2016 and 10/2022 was performed. ICE was incorporated into the practice in 11/2018. Cases were divided into two groups: ICE or conventional. Cases were reviewed for time between hepatic (HV) and portal vein (PV) access (calculated by time from hepatic venogram to wire access into the PV) and categorized by operator and use of ICE. Differences in PV access time were compared using a Mann-Whitney U test. A total of 176 cases were reviewed; 89/176 (51%) used ICE. PV access times were significantly shorter when using ICE compared to when ICE was not used (33 vs 51 min, p = 0.002). Comparing the access times for cases without ICE and the first 5 cases with ICE for each provider, there was a significant reduction in time (38.5 vs 64 min, p = 0.009). PV access times using ICE did not significantly decrease over time following ICE adoption (p = 0.056). There appears to be a short learning curve for utilization of ICE for TIPS creation, with significant time savings in PV access seen within the first few instances of ICE use. Recognition of this short learning curve may make ICE-guidance during TIPS creation more attractive to interventional radiologists or institutions considering adoption of this technique.