REGULAR CONTENT
Final ID
652
Type
Educational Exhibit-Poster Only
Authors
S Garg1, M Kolber1, P Shukla1, R Patel1
Institutions
1Mount Sinai Beth Israel, New York, NY
Purpose
Transsplenic portal venous (TSPV) access is increasingly utilized for interventions involving the portal venous system and associated variceal pathology, especially in cases of portal vein thrombosis or when sparing a future liver remnant from percutaneous intervention. The purpose of this study is to systematically review the efficacy and risk of TSPV interventions in the published literature.
Materials & Methods
A MEDLINE (PubMed) search from June 1954 to August 2016 was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Search parameters included studies in the English language with adult human subjects receiving TSPV access for any indication. Intervention type, reason for TSPV access, needle and sheath size, and technical success were recorded. Major and minor complications were defined by the Society of Interventional Radiology Clinical Practice Guidelines.
Results
Twenty-one studies consisting of 156 patient-cases (mean age 51 years, range 22-74) met the inclusion criteria. There were 9 retrospective reviews and 12 case series/reports. Portal interventions performed after TSPV access included variceal embolization (n=76), portal vein recanalization with transjugular intrahepatic portosystemic shunt (n=50), portal vein embolization (n=26), portal vein angioplasty/portal vein stenting (n=10), and splenic vein covered stent placement (n=1). Technical success was 95.5%. Fluoroscopic guidance alone was used in 64 cases, associated with 8 major and 8 minor episodes of hemorrhage. Ultrasound guidance was utilized in 92 cases, associated with no major and 2 minor bleeds. An increased risk of procedure-related bleeding with fluoroscopic guidance compared to ultrasound guidance was statistically significant (p < 0.01). Larger access needle or sheath caliber was not associated with increased complication rate.
Conclusions
TSPV access is safe, effective, and may offer technical advantages in certain clinical settings. Ultrasound guidance may be associated with a lower risk of procedure-related bleeding.
Final ID
652
Type
Educational Exhibit-Poster Only
Authors
S Garg1, M Kolber1, P Shukla1, R Patel1
Institutions
1Mount Sinai Beth Israel, New York, NY
Purpose
Transsplenic portal venous (TSPV) access is increasingly utilized for interventions involving the portal venous system and associated variceal pathology, especially in cases of portal vein thrombosis or when sparing a future liver remnant from percutaneous intervention. The purpose of this study is to systematically review the efficacy and risk of TSPV interventions in the published literature.
Materials & Methods
A MEDLINE (PubMed) search from June 1954 to August 2016 was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Search parameters included studies in the English language with adult human subjects receiving TSPV access for any indication. Intervention type, reason for TSPV access, needle and sheath size, and technical success were recorded. Major and minor complications were defined by the Society of Interventional Radiology Clinical Practice Guidelines.
Results
Twenty-one studies consisting of 156 patient-cases (mean age 51 years, range 22-74) met the inclusion criteria. There were 9 retrospective reviews and 12 case series/reports. Portal interventions performed after TSPV access included variceal embolization (n=76), portal vein recanalization with transjugular intrahepatic portosystemic shunt (n=50), portal vein embolization (n=26), portal vein angioplasty/portal vein stenting (n=10), and splenic vein covered stent placement (n=1). Technical success was 95.5%. Fluoroscopic guidance alone was used in 64 cases, associated with 8 major and 8 minor episodes of hemorrhage. Ultrasound guidance was utilized in 92 cases, associated with no major and 2 minor bleeds. An increased risk of procedure-related bleeding with fluoroscopic guidance compared to ultrasound guidance was statistically significant (p < 0.01). Larger access needle or sheath caliber was not associated with increased complication rate.
Conclusions
TSPV access is safe, effective, and may offer technical advantages in certain clinical settings. Ultrasound guidance may be associated with a lower risk of procedure-related bleeding.