Intravascular ultrasound in transjugular intrahepatic portosystemic shunt creation: a systematic review and meta-analysis comparing conventional transjugular intrahepatic portosystemic shunt with intravascular ultrasound -guided transjugular intrahepatic portosystemic shunt

Abstract Objectives This systematic review and meta-analysis evaluate the clinical and procedural benefits of intravascular ultrasound (IVUS)–guided portal vein access during transjugular intrahepatic portosystemic shunt (iTIPS) creation compared to the conventional TIPS (cTIPS) technique. Methods A comprehensive search of Medline and Google Scholar through August 30, 2024, was conducted to identify retrospective studies comparing iTIPS and cTIPS. A total of six studies, involving 418 patients (180 undergoing iTIPS and 238 undergoing cTIPS), met inclusion criteria. Matched comparison groups were used to analyze outcomes. Results Technical success rates were similar between iTIPS and cTIPS groups. One study reported a significantly lower complication rate with iTIPS, while three studies found no differences in complications. Notably, iTIPS significantly reduced fluoroscopy time by 9.74 min (P < .001) and radiation exposure by 583.4 mGy (P < .001) compared to cTIPS. The total procedure time and portal venous access time were shorter by 21 min (P < .001) and 15.49 min (P < .001), respectively, with IVUS guidance. Additionally, contrast agent use was 69.62 cc lower (P < .001) in iTIPS cases. Conclusion Although based on a limited number of studies, these findings support IVUS-guided TIPS as a superior technique for improving procedural efficiency and reducing radiation exposure, procedure times, and contrast agent usage without compromising success rates. Its benefits are particularly pronounced in patients with complex anatomy or heightened risk factors. Advances in knowledge IVUS-guided TIPS demonstrates potential procedural and safety advantages over conventional techniques, particularly in anatomically complex or high-risk patients. These findings support further investigation and prospective validation.