Abstract No. 611 Left-sided portal hypertension in the presence or absence of splenic vein thrombosis: a single tertiary center experience

Abstract

Purpose: Stenosis within TIPS reduces its effectiveness to lower portal hypertension (PH), increasing the risk of variceal bleeding/ ascites. Reports have variably suggested both positive and negative correlations between abnormal duplex ultrasonography (DU) and TIPS dysfunction. At our institution, all TIPS patients with abnormal DU undergo angiographic/hemodynamic studies prior to shunt revision. This study examines the effectiveness of DU for surveillance after TIPS for PH with ascites. Materials: A 12 year retrospective review of TIPS procedures for ascites was performed. Using Medical Imaging/IR databases, patients with abnormal DU studies were extracted; TIPS dysfunction on ultrasound was suggested by hepatopetal branch portal vein flow, marked focal increase in TIPS velocity, TIPS velocity 8mm Hg. The patients' angiographic and hemodynamic records were compared with DU exams to determine the effectiveness of DU. Results: 134 angiographic/hemodynamic studies were performed on 69 TIPS patients whose DU surveillance study suggested TIPS dysfunction. 71 had focal or diffuse TIPS stenosis (53% DU positive predictive value), and 63 had no stenosis (47% false positive rate). PSG (N ¼ 128) was > 8mm Hg in 72 studies (56% DU positive predictive value), and ¼ /< 8mm Hg in 56 studies )44% false positive rate). Based on the angiographic/hemodynamic results, intervention was avoided in 42/134 (32%). Conclusions: DU is not an effective non-invasive surveillance tool after TIPS, since there is no positive correlation between abnormal DU and angiographic/hemodynamic studies. However, since there is presently no better non-invasive test demonstrating TIPS dysfunction, angiographic/hemodynamic studies remain necessary to confirm the results of DU studies prior to intervention. Abstract No. 611Left-sided portal hypertension in the presence or absence of splenic vein thrombosis: a single tertiary center experience

Imaging of Portal Gastroduodenopathy

“…Lymphoproliferative disease can also cause nonthrombotic left-sided portal hypertension. 24 As a result of splenic vein obstruction, the short gastric veins route the splenic venous flow to the stomach leading to formation of collaterals in the gastric fundus.…”