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BackTable / VI / Podcast / Episode #285

TIPS with ICE Guidance

with Dr. Merve Ozen

In this episode, host Dr. Aparna Baheti interviews Dr. Merve Ozen, interventional radiologist, about how to integrate ICE for TIPS, including why she uses a vampire stick, her needle preference, and tips for single operators.

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TIPS with ICE Guidance with Dr. Merve Ozen on the BackTable VI Podcast)
Ep 285 TIPS with ICE Guidance with Dr. Merve Ozen
00:00 / 01:04

BackTable, LLC (Producer). (2023, January 23). Ep. 285 – TIPS with ICE Guidance [Audio podcast]. Retrieved from https://www.backtable.com

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Podcast Contributors

Dr. Merve Ozen discusses TIPS with ICE Guidance on the BackTable 285 Podcast

Dr. Merve Ozen

Dr. Merve Ozen is a practicing interventional radiologist with University of Kentucky Healthcare.

Dr. Aparna Baheti discusses TIPS with ICE Guidance on the BackTable 285 Podcast

Dr. Aparna Baheti

Dr. Aparna Baheti is a practicing Interventional Radiologist in Tacoma, Washington.

Synopsis

Dr. Ozen begins by discussing the challenges she faced when introducing this new technique into her practice at the University of Kentucky. She faced pushback from administration about procedure time and anesthesia time. She now does all her TIPS with intracardiac echocardiography (ICE) guidance, but she keeps CO2 available in case of device malfunction, which would cause her to revert to the traditional method of CO2 angiography.

It takes time to learn how to navigate the ICE probe, also called intravascular ultrasound (IVUS), but it helps with complicated cases like thrombosed portal veins and Budd-Chiari syndrome. She uses the “vampire stick” technique, which is a side by side internal jugular access technique for the TIPS needle and the US probe. She puts her TIPS access more medial, which makes it more stable, and places her ICE access more lateral.

After getting access, she spends time understanding the anatomy in the liver. Prior CT is useful for getting information about patient specific anatomy. She then uses ICE to view the portal vein and hepatic vein on the same plane, then she advances the needle with one stick. Dr. Ozen prefers a Rösch-Uchida needle versus a Colapinto because she feels she can better visualize it with ICE. One thing she recommends spending time on is understanding where to start introducing your needle. If there is clot or liver stuck in the needle and preventing blood return, she recommends flushing the needle, or advancing it and then pulling back gently. She ends by stating that learning how to operate the ICE probe is a steep learning curve, but one that every IR should invest time in. It cuts down on anesthesia and fluoroscopy time, and provides a level of safety that is simply not achievable with traditional methods.

Resources

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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Articles

Topics

Cirrhosis Condition Overview
Intravascular Ultrasound (IVUS) Procedure Prep
Liver Disease Condition Overview
Portal Hypertension Condition Overview
TIPS Procedure Steps & Technique

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