Abstract No. 525 Is It Time To Upgrade to iTIPS? Intravascular Ultrasound-Guided versus Conventional Transjugular Intrahepatic Portosystemic Shunt

Transjugular intrahepatic portosystemic shunt (TIPS) is considered the standard of care to treat patients with refractory sequala of cirrhosis and portal hypertension. Getting access into the portal vein is often the most critical part of the procedure accounting for most of the radiation dose. Intravascular ultrasound (IVUS) can provide real-time visualization of the hepatic and portal vein anatomy, potentially reducing the portal vein (PV) access time. The purpose of this study is to compare the time to get PV access and radiation dose between IVUS-guided (iTIPS) and conventional TIPS (cTIPS). In this single-center retrospective study, all patients who underwent TIPS between July 2017 and August 2023 were included. Patients with emergent TIPS, concurrent variceal embolization, concurrent portal vein recanalization, or those with Budd-Chiari syndrome were excluded from the study. PV access time was calculated from the first fluoroscopy image till PV access and included time to get access into the hepatic vein and portal vein. The primary outcome was time to PV access. The secondary outcomes were needle passes > 2, fluoroscopy (FL) time, fluoroscopy dose, and complication rate. Contrast volume recording was limited retrospectively and was not included in the final analysis. Statistical significance was accepted at p< 0.05. A total of 192 patients underwent TIPS during the study period. Among those, 9 and 59 patients were included in the iTIPS and cTIPS groups. There was no significant difference in background demographic variables and MELD score between the two study groups (Table 525.1, p >0.05). The mean PV access time was significantly lower in iTIPS compared to cTIPS (45.7±23.6 mins vs 96.5±60.5 mins, p< 0.001). No patient in iTIPS group required more than 2 needle passes for PV access while 66.1% of patients in the cTIPS group required more than 2 needle passes (p< 0.001). The mean FL time was shorter (22.4±6.4 vs 48.5±26.8 mins) and the average FL dose was lower (289.4±179.9 vs 1322.8±1589.8 mGy) in iTIPS vs cTIPS groups (both p< 0.001). No capsular injury or intraperitoneal bleeding was reported in either group (p=1). Real-time visualization by IVUS during TIPS creation decreases the time to get PV access and improves patient safety by reducing radiation exposure and the number of needle passes.