Radiation exposure during transjugular intrahepatic portosystemic shunt creation in patients with complete portal vein thrombosis or portal cavernoma

Background This study aims to evaluate radiation exposure in patients with complete portal vein thrombosis (CPVT) or portal cavernoma (PC) undergoing transjugular intrahepatic portosystemic shunt (TIPS) creation using real-time ultrasound guidance for portal vein targeting. Materials and methods This is a single institution retrospective analysis. Between August 2009 and September 2018, TIPS was attempted in 49 patients with CPVT or PC. Radiation exposure (dose area product [DAP], air KERMA (AK) and fluoroscopy time [FT]), technical success, clinical success, complications and survival were analyzed. Results In total, 29 patients had CPVT and 20 patients had PC. 41/49 patients had cirrhosis. TIPS indications were refractory ascites ( n = 25), variceal bleeding ( n = 16) and other ( n = 8). TIPS was successfully placed in 94% (46/49) of patients via a transjugular approach alone ( n = 40), a transjugular/transhepatic approach ( n = 5) and a transjugular/transsplenic approach ( n = 1). Median DAP was 261 Gy * cm 2 (range 29–950), median AK was 0.2 Gy (range 0.05–0.5), and median FT was 28.2 min (range 7.7–93.7). Mean portosystemic pressure gradient decreased from 16.8 ± 5.1 mmHg to 7.5 ± 3.3 mmHg ( P