From the Guidelines
The appropriate needle size for a Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedure is 8-10 mm.
Rationale
- The choice of needle size is crucial in balancing the risk of hepatic encephalopathy (HE) and achieving adequate portal pressure reduction 1.
- A study published in Gut found that larger diameter portosystemic shunts are associated with a greater risk of HE, while smaller diameter stents may not achieve adequate portal pressure reduction 1.
- The French guidelines on TIPS recommend initially expanding the shunt to 8 mm, with consideration for expansion to 10 mm if necessary, based on the target portosystemic gradient (PPG), patient comorbidities, and TIPS indication 1.
- North American practice-based recommendations suggest considering small caliber TIPS creation in select patients who develop portal hypertensive-associated complications after shunt embolization, but do not specify a particular needle size 1.
- Overall, the evidence suggests that a needle size of 8-10 mm is appropriate for TIPS procedures, with the specific size depending on individual patient factors and the target PPG.
From the Research
Needle Size for TIPS Procedure
- The appropriate needle size for a Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedure is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
- However, a study from 2006 5 describes a method using sonographic guidance to serially puncture the portal vein and hepatic vein with a single transhepatic needle pass, but it does not specify the needle size.
- Another study from 2022 2 mentions a modified gun-sight TIPS technique that utilizes typically on-shelf and low-cost equipment for a targeted fluoroscopic-guided parenchymal puncture, but it also does not provide information on the needle size.
- The other studies 3, 4, 6 focus on the indications, patient selection, and outcomes of TIPS procedures, but do not discuss the needle size.
Available Information
- The studies provide information on the techniques, indications, and outcomes of TIPS procedures, but lack specific details on the needle size used.
- Further research or consultation of medical guidelines may be necessary to determine the appropriate needle size for a TIPS procedure.