The inaccuracy of duplex ultrasonography in predicting patency of transjugular intrahepatic portosystemic shunts☆

Owens, Charles; Bartolone, Christopher; Warner, David L.; Aizenstein, Robert I.; Hibblen, John; Yaghmai, Babak; Wiley, Tisha R. A.; Layden, Thomas J.

doi:10.1016/s0016-5085(98)70317-8

Cited by 76 publications

(39 citation statements)

References 24 publications

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“…11,18 Results from Doppler ultrasound were confirmed with angiography. Stenosis was defined on angiography if there was 50% or greater narrowing of the lumen and/or the portosystemic gradient was 12 mm Hg or greater.…”

Section: Definition Of Termsmentioning

confidence: 82%

Predictors of mortality and stenosis after transjugular intrahepatic portosystemic shunt

M.D.

Jacques

Mauro

et al. 2002

Liver Transplantation

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Transjugular intrahepatic portosystemic shunts (TIPSs) are used to treat variceal hemorrhage and refractory ascites. We sought to determine factors associated with stenosis and mortality after TIPS placement in patients with end-stage liver disease. This is a retrospective review of 90 TIPSs placed over a 3-year period. Demographic, clinical, and biochemical parameters were analyzed in univariate analyses to determine their association with stenosis and death. Multivariate analyses were conducted using logistic regression and Cox proportional hazard modeling. Thirty-five TIPSs were placed for recurrent variceal bleeding; 14 TIPSs, for uncontrolled variceal bleeding; 34 TIPSs, for refractory ascites; and 7 TIPSs, for other causes. The overall mortality rate was 33%, and 18 patients died within 30 days of TIPS placement. The 1-year stenosis rate was 49%. Fourteen patients underwent liver transplantation a mean of 116 ؎ 143 days after TIPS placement. Prothrombin time greater than 17 seconds, serum creatinine level greater than 1.7 mg/dL, total bilirubin level greater than 3 mg/dL, and uncontrolled variceal bleeding as an indication for TIPS placement were significant predictors of 30-day mortality. Serum creatinine level was a predictor of 30-day mortality in individuals with recurrent variceal hemorrhage or ascites. Multivariate analyses showed that creatinine level greater than 1.7 mg/dL and uncontrolled variceal bleeding as an indication for TIPS placement were independently associated with 30-day mortality. Individuals with both coagulopathy and renal insufficiency had a 30-day mortality rate of 78%. Urgent placement of TIPS was associated with an increased risk for stenosis (hazard ratio ‫؍‬ 4.5; 95% confidence interval, 1.9 to 10.1; P < .001), but no other clinical variables were associated with stenosis. Uncontrolled variceal bleeding as an indication for TIPS placement, coagulopathy, hyperbilirubinemia, and renal insufficiency were associated with increased mortality in patients with TIPSs. Individuals with both coagulopathy and renal insufficiency had high mortality. Urgent TIPS placement for uncontrolled variceal bleeding was associated with stenosis. (Liver Transpl 2002;8:271-277.) T ransjugular intrahepatic portosystemic shunts (TIPSs) are used to treat sequelae of portal hypertension that are not responsive to medical and endoscopic therapy. A TIPS is effective in stopping acute variceal bleeding and preventing rebleeding from varices refractory to endoscopic and medical therapy. [1][2][3][4][5] Ascites refractory to diuretic therapy is effectively treated with TIPS placement. 6,7 TIPS placement is effective in reducing variceal rebleeding rates to 10% over 1 year and may be effective in treating ascites in 60% of patients. 6 Although TIPS placement is effective in reducing portal hypertension, it is associated with a high stenosis rate. Stenosis occurs in 50% of TIPSs at 1 year. 8 Stenosis is a result of several factors, one of which is neointimal hyperplasia within the stent. 9 Surveillance for steno...

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Section: Definition Of Termsmentioning

confidence: 82%

Predictors of mortality and stenosis after transjugular intrahepatic portosystemic shunt

M.D.

Jacques

Mauro

et al. 2002

Liver Transplantation

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“…47 In a second series of 31 occluded or stenotic stents, ultrasound predicted shunt malfunction in only 11 and incorrectly predicted patency in 20; thus the sensitivity was only 35%. 48 Many of the sonographic studies are methodologically flawed, because sonographic criteria of shunt dysfunction were used to trigger TIPS venography; however, when sonography suggested no shunt dysfunction, proof of shunt patency via venography was not performed. Part of the difficulty of using sonography is that it is an imaging technique that measures velocity, from which diameter within a conduit can be estimated.…”

Section: Complicationsmentioning

confidence: 99%

The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension

2005

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“…[4][5][6][7] The accuracy of splenoportal venous velocities for detecting TIPS dysfunction may diminish by the involvement of splenoportal venous hemodynamics in portal hypertension, since the size and location of portosystemic collateral development differ from patient to patient and can profoundly affect portal venous flow. Although some pitfalls of using portal venous Doppler parameters to assess TIPS function have been reported, 8,9 Doppler velocities sampled in the splenoportal veins are still considered noninvasive indirect indicators for monitoring the development of TIPS dysfunction.…”

mentioning

confidence: 99%

Shear Wave Elastography of the Spleen for Monitoring Transjugular Intrahepatic Portosystemic Shunt Function

Gao¹,

Xiao

Zheng

et al. 2016

J of Ultrasound Medicine

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A Pilot Studyhe transjugular intrahepatic portosystemic shunt (TIPS) is used for management of refractory acute variceal hemorrhage and intractable ascites in late-stage liver diseases with portal hypertension. 1 In addition to monitoring the clinical status, it is important to monitor TIPS hemodynamic function objectively. 2,3 Although the portosystemic pressure gradient (PPG) and hepatic venous pressure gradient are still considered the reference standards for diagnosis and monitoring of portal hypertension, they Jing Gao, MD, Xiao Zheng, MS, Yuan-Yi Zheng, MD, Guo-Qing Zuo, MD, Hai-Tao Ran, MD, Yong Ho Auh, MD, Levi Waldron, PhD, Tiffany Chan, MS, Zhi-Gang Wang, MD Received July 6, 2015, Objectives-To assess the feasibility of splenic shear wave elastography in monitoring transjugular intrahepatic portosystemic shunt (TIPS) function.Methods-We measured splenic shear wave velocity (SWV), main portal vein velocity (PVV), and splenic vein velocity (SVV) in 33 patients 1 day before and 3 days to 12 months after TIPS placement. We also measured PVV, SVV, and SWV in 10 of 33 patients with TIPS dysfunction 1 day before and 3 to 6 days after TIPS revision. Analyses included differences in portosystemic pressure gradient (PPG), PVV, SVV, and mean SWV before and after TIPS procedures; comparison of median SWV before and after TIPS procedures; differences in PVV, SVV, and SWV before and at different times up to 12 months after TIPS placement; accuracy of PVV, SVV, and SWV in determining TIPS dysfunction; and correlation between PPG and SWV.Results-During 12 months of follow-up, 23 of 33 patients had functioning TIPS, and 10 had TIPS dysfunction. The median SWV was significantly different before and after primary TIPS placement (3.60 versus 3.05 m/s; P = .005), as well as before and after revision (3.73 versus 3.06 m/s; P = .003). The PPG, PVV, and SVV were also significantly different before and after TIPS placement and revision (P < .001). The PPG and SWV decreased, whereas PVV and SVV increased, after successful TIPS procedures. A positive correlation was observed between PPG and SWV (r = 0.70; P < .001), and a negative correlation was observed between PPG and PVV and SVV (r = -0.65; P < .001). The areas under the receiver operating characteristic curve for PVV, SVV, and SWV in determining TIPS dysfunction were 0.82, 0.84, and 0.81, respectively.Conclusions-Splenic SWV is compatible with splenoportal venous velocity in quantitatively monitoring TIPS function and determining TIPS dysfunction.

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The inaccuracy of duplex ultrasonography in predicting patency of transjugular intrahepatic portosystemic shunts☆

Cited by 76 publications

References 24 publications

Predictors of mortality and stenosis after transjugular intrahepatic portosystemic shunt

Predictors of mortality and stenosis after transjugular intrahepatic portosystemic shunt

The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension

Shear Wave Elastography of the Spleen for Monitoring Transjugular Intrahepatic Portosystemic Shunt Function

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