Percutaneous ultrasound-guided intrahepatic portosystemic shunt (TIPS)

Patricio Vargas-Hudson, Departamento de Imágenes, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
Roberto Muñoz-Estrada, Departamento de Imágenes, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
Benjamín Horwitz-Zanolli, Departamento de Imágenes, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
Juan Niedmann-Espinosa, Departamento de Imágenes, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
Gian Zamboni-Torres, Departamento de Imágenes, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
Sebastián Glaria-Grego, Departamento de Imágenes, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
Antonio Vallejos-Cabezas, Departamento de Imágenes, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
Nicolás Radic-González, Departamento de Imágenes, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile

Introduction: The transjugular intrahepatic portosystemic shunt (TIPS) is a procedure used to reduce portal system pressure. The main difficulty of the conventional technique lies in accessing the portal vein from the hepatic vein. Objective: To evaluate the technical feasibility, safety, and clinical outcomes of TIPS creation using an ultrasound-guided percutaneous transhepatic approach in an institutional case series. Material and methods: A retrospective study was conducted including patients between 2007 and 2024, who underwent a technical variant of the TIPS procedure consisting of a percutaneous transhepatic parietal access guided by ultrasound. Results: The technique achieved 100% technical success and single-attempt portal access, leading to low fluoroscopy times and radiation doses. Portal gradient reduced by 10 mmHg average. The technique overcomes the “blind” access limitation, optimizing safety and radiation exposure. Complications and patency are consistent with the literature. Conclusions: The ultrasound-guided percutaneous transhepatic approach for TIPS creation is safe and effective in our institutional experience, allowing for reduced puncture times and radiation exposure.

Keywords: Transjugular intrahepatic portosystemic shunt. TIPS. Portal hypertension. Ultrasound. Percutaneous procedures.