From the Guidelines
For a TIPS procedure, the recommended needle size for initial hepatic vein access is typically a 21-gauge or 22-gauge needle, such as a Colapinto or a Rosch-Uchida needle, to minimize complications and ensure a successful procedure 1.
Key Considerations
- The use of a small-diameter coated stent of less than 10 mm is preferred to reduce the likelihood of post-TIPS complications, including hepatic encephalopathy 1.
- A covered stent with a diameter of 8–10 mm is commonly used in TIPS procedures, and is associated with a significantly reduced risk of variceal bleeding recurrence compared to uncovered stents 1.
- The choice of equipment, including the needle size, should take into account the patient's age, size, and anatomy, particularly in children, where technical challenges may arise 1.
Equipment Specifications
- A 10-Fr or 11-Fr introducer sheath and a 10-mm or 12-mm diameter balloon catheter are typically used in TIPS procedures.
- The needle size specifically for the initial hepatic vein access is usually a 21-gauge or 22-gauge needle, such as a Colapinto or a Rosch-Uchida needle.
From the Research
Needle Size for TIPS Procedure
The recommended needle size for a Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedure is not explicitly stated in the provided studies. However, the studies discuss the use of different diameter Wallstents, which may be relevant to the procedure.
Wallstent Diameter
- A study from 1996 2 compared the results of TIPS placement with 10- and 12-mm Wallstents, and found that 12-mm Wallstents yielded poorer short- and long-term results.
- The study suggests that the decreased radial strength of the larger stent may be responsible for the poorer results.
- Another study from 2020 3 discusses the possible role of small diameter TIPS to prevent post-procedural complications.
TIPS Procedure
- The TIPS procedure is used to relieve portal hypertension and its complications, such as variceal hemorrhage, ascites, and hepatorenal syndrome 4, 5.
- The procedure involves the placement of a shunt between the portal and hepatic veins, which can be done using a variety of techniques and materials.
- The choice of needle size and Wallstent diameter may depend on the specific procedure and the patient's individual needs.
Complications and Considerations
- The TIPS procedure can be associated with complications such as hepatic encephalopathy, heart failure, and shunt stenosis or occlusion 6, 2, 3, 5.
- Careful patient selection and assessment of cardiac and renal function prior to the procedure may help to improve outcomes and reduce the risk of complications 3, 5.