From the Guidelines
For a TIPS procedure, a needle size is not explicitly recommended in the provided evidence, however, the most relevant information for the procedure is the use of covered stents with a diameter of 8–10 mm and an average final dilation of 7–8 mm 1.
Key Considerations
- The technical challenges of TIPS placement in children, particularly those under 2 years of age or weighing less than 10 kg, require careful selection of equipment 1.
- The primary indication for TIPS is recurrent and/or refractory ascites, with a lower clinical response rate after liver transplant 1.
- Covered stents are associated with a significantly reduced risk of variceal bleeding recurrence compared to uncovered stents (p = .01; coefficient: −1.813; 95% CI 3.26–.41) 1.
Equipment Selection
- Covered stents with a diameter of 8–10 mm are commonly used for TIPS procedures 1.
- The average final dilation of the stent is typically 7–8 mm 1.
- The choice of equipment, including the type of stent and its size, should be based on individual patient anatomy and procedural requirements 1.
Patient-Specific Factors
- Patient age, size, and anatomy can impact the technical success of the TIPS procedure 1.
- A thorough assessment of the patient's anatomy is crucial before considering TIPS, particularly in children with extrahepatic portal vein thrombosis or anatomical peculiarities 1.
From the Research
Recommended Needle Size for TIPS Procedure
- The recommended needle size for a Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedure is a 21-gauge long PTC needle, as used in a study published in 1994 2.
- This study introduced a new coaxial needle system, hepatic artery targeting wire, and biplane fluoroscopy to increase safety and efficacy of the TIPS procedure.
- The use of a 21-gauge needle allowed for successful puncture of the right portal vein and introduction of a 0.035-inch working guidewire, with no technical difficulties or complications encountered in seven patients with postnecrotic cirrhosis.
Comparison with Other Needle Sizes
- Other studies have compared the efficacy and safety of different needle sizes for various medical procedures, including liver biopsies 3, 4 and lung biopsies 4, 5.
- These studies suggest that larger gauge needles (e.g. 16-gauge) may be associated with higher success rates and fewer complications, but the optimal needle size may depend on the specific procedure and tissue type.
- However, these studies are not directly relevant to the TIPS procedure, and the recommended needle size for TIPS remains a 21-gauge long PTC needle, as supported by the study published in 1994 2.