Intraoperative cone-beam CT during the transjugular intrahepatic portosystemic shunt procedure

To evaluate the identification of portal vein (PV) entry by intraoperative cone-beam CT (CBCT) during the transjugular intrahepatic portosystemic shunt (TIPS) procedure. From February 2018 to February 2020, 73 patients underwent TIPS due to severe portal hypertension, and 28 of them underwent intraoperative CBCT angiography. In the CBCT and digital subtraction angiography (DSA) groups, the primary indicators included the number of punctures, PV puncture time, and PV entry scoring and the secondary indicators included shunt angle (SA), contrast volume, and dose area product (DAP) were evaluated, respectively. The number of punctures and PV puncture time in the CBCT group were (2.3 ± 0.9) and (9.2 ± 1.8) min that both less than (4.2 ± 1.5) and (20.4 ± 2.1) min in the DSA group, respectively, and PV entry scoring was better in the CBCT group (all P  < 0.05). The DAP was (224.3 ± 46.3) Gy×cm 2 in the CBCT group and (180.9 ± 29.3) Gy×cm 2 in the DSA group, which showed a significant increase ( P  < 0.05). However, SA and contrast volume showed no significance between the two groups. Intraoperative CBCT can accurately identify PV entry for some difficult TIPS procedures but results in increased radiation exposure.