3D C-Arm cone beam CT for targeting the portal vein during TIPS: Initial clinical experience

Purpose: To evaluate the feasibility, safety and usefulness of 3D CBCT with a new injection protocol for targeting the portal vein during TIPS and to determine if it allows decreasing the duration of the procedure. Materials and methods: 3D CBCT was obtained during creation of TIPS in 15 patients (group 2). Portogram quality score was defined using a 5 points scale. The time required to achieve portal puncture was also recorded and results were compared retrospectively in 15 patients who underwent TIPS without 3D CBCT (group 1). Results: The mean time required to puncture the portal vein was shorter when CBCT was used: 15 min versus 24 min (p = 0.156). We recorded 3 failures requiring a second procedure in group 1. There were no complications and no failure in group 2. We recorded 93% of good portography and 80% of good 3D roadmaps. Conclusion: 3D CBCT coupled with this new injection protocol provided high rate of good quality portography allowing to bring positional and directional information to improve the needle pass efficiency and to decrease the duration of the procedure.