Adjunctive 3D US for achieving portal vein access during transjugular intrahepatic portosystemic shunt procedures (vol 11, pg 611, 2000)

PURPOSE: To evaluate the usefulness of information provided by three-dimens ional ultrasound (3D US) and to determine whether 3D US decreased the numbe r of passes required to obtain portal vein (PV) access during creation of t ransjugular intrahepatic portosystemic shunts (TIPS), MATERIALS AND METHODS: Intermittent 3D US volume acquisitions were obtained during creation of TIPS in 20 patients, Useful information provided by 3D US was tabulated. The number of passes required to achieve PV access was re corded and results were compared retrospectively to 25 patients who underwe nt TIPS without 3D US. RESULTS: 3D US documented that the operator's opinion of which hepatic vein had been selected was incorrect in nine patients (45%), detected unfavorab le PV anatomy that required modification of equipment or technique in seven patients (35%), permitted estimation of the trajectory required to access the targeted PV in all patients (100%), assisted in selecting the optimal p oint along the hepatic vein for origination of the needle pass in 11 patien ts (55%), allowed avoidance of a large hepatocellular carcinoma in one pati ent (5%), and confirmed that access into the main PV was intrahepatic in fo ur patients (20%). The mean number of needle passes decreased from 10.4 in the historic control group to 4.6 in the 3D US group (P = .0001), CONCLUSION: 3D US provided imaging information that detected technical erro rs and altered anatomy, and provided positional and directional information to significantly improve needle pass efficiency.