Educational Exhibit Abstract No. 302 - Cone beam CT planning and guidance for TIPS in patients with portal vein thrombosis

Abstract

Learning Objectives To demonstrate the use of Cone beam CT guidance. To plan the tract for TIPS to the SMV. To demonstrate the techniques of software analysis to aide in TIPS creation where no Portal vein exists. Background Transjugular Intrahepatic Portosystemic Shunt (TIPS) placement has been proven effective in lowering portal venous pressure, thereby reducing complications in patients with portal hypertension(1) and it also reconstructs portal vein flow(2) in patients with portal vein thrombosis. Portal vein thrombosis makes it very difficult both technically and in the effectiveness of the shunt, with only 40% - 66% success reported(3). Portal vein atrophy and development of portal cavernoma makes it more difficult if delay occurs in performing the TIPS. Different techniques have been suggested by transhepatic and transsplenic approach in performing the procedure. Most of these procedures involve recanalisation of the portal vein by thrombectomy or stenting. Cone Beam CT guidance gives a path of direction by utilizing the 3D registration software, created by the Cone beam CT which is used to perform on-table angiography and mark the location of the occluded portal vein and present a target for placement of the needle into the SMV through a path that avoids bowel and other vital structures. Clinical Findings/Procedure Details Six cases of bleeding patients (age 11 to 67) with Portal Hypertension and clinically occluded PV will be described, including planning techniques, mapping and position of needle. Outcomes including surgical consideration for future transplant will be discussed. Conclusion and/or Teaching Points Cone Beam CT involvement in the interventional radiology procedures is an innovation with various applications growing day by day and this poster will familiarize with the uses of Cone Beam CT and TIPS creation in patients with occluded PV.