Safety and Feasibility of Gun-Sight Technique for Transjugular Intra-hepatic Portosystemic Shunt (TIPS) Creation

Purpose To review technical details, indications for use, success rates and complications of gun-sight technique for transjugular intra-hepatic portosystemic shunt (TIPS) creation. Materials and Methods A multicenter retrospective review was performed. Forty-two TIPS procedures with gun-sight technique were identified between 2016 and 2021. Eighty-six percent of patients had portal vein thrombosis (PVT), and 21% had undergone prior failed TIPS creation. Demographics, procedure details and outcomes were reviewed. Differences between the groups, event rates and patency rates were evaluated using nonparametric two-sample Wilcoxon rank-sum (Mann–Whitney) test, Fisher’s exact test, Kaplan–Meier curves, and log-rank test. Results Technical success was 98%. Sixty-seven percent of subjects had transsplenic and 26% had transhepatic access for TIPS creation. Twenty-one adverse events were noted (48%), four of which were definitely related and four were probably related to the use of gun-sight technique. Early (within 90 days) thrombosis occurred in 7/41 patients (17%), all of whom had existing PVT. Conclusion Gun-sight technique for TIPS creation has a high success rate in this challenging cohort of patients. While complications can occur, most of the adverse events noted were likely associated with TIPS creation itself rather than gun-sight. Early thrombosis only occurred in patients with PVT. Level of Evidence Level 4, Case Series. Graphic Abstract