THE ROLE OF MR-ANGIOGRAPHY BEFORE TRANSJU GULAR PLACEMENT OF A PORTOSYSTEMIC STENT-SHUNT (TIPS)

The authors employed magnetic resonance angiography (MRA) to guide cat heter placement for transjugular intrahepatic portosystemic stent shun t (TIPS) procedures in 14 of 24 patients, and compared the results to the 10 patients who did not have prior planning based on MRA. Two-dime nsional time-of-flight venography was performed during breath holding, and projection venograms were formatted in sagittal, coronal and axia l planes. MRA defined venous anatomy sufficiently well to shorten the procedure and helped to minimize invasiveness. With MRA guidance, intr ahepatic needle punctures were significantly fewer (without MRA guidan ce: mean 12.1; with MRA guidance: mean 3.5, p<0,001) and associated co mplications were absent (without MRA guidance: failed placement, N = 1 ; bleeding requiring blood transfusions, N = 2; death complicating int raperitoneal haemorrhage with haemobilia, N = 1, and hepatic capsular perforation, N = 1). The average time for the procedure was 2.8 hours without MRA guidance and 1.8 hours with MRA guidance (p < 0,0005). The authors conclude that MR angiography is a useful technique to define, portal and hepatic venous anatomy prior to TIPS, and planning based o n MRA may decrease the difficulty and length of the procedure.