TIPS: Color-Doppler Follow-Up

Ricci, Paolo; Pizzi, G.; Coniglio, M.; Cantisani, Vito; Pepino, Daniela; Rossi, Plinio

doi:10.1007/978-3-642-57116-9_24

Cited by 1 publication

(8 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In our personal experience we have obtained results similar to those published by Kanterman, concerning the focal velocity elevation in the presence of stenosis, but it is not so easy to define correctly a range of velocities [17]. Another issue to be borne in mind is that after TIPS is usually documented an increase of the portal vein velocity due to the effectiveness of shunt as a low-pressure conduit bypassing the hepatic circulation [4]. Therefore, Doppler evaluation of the main portal vein is complementary in the assessment of the shunt itself, and post-TIPS velocities should be compared with pre-TIPS examination.…”

Section: Functioning Shuntssupporting

confidence: 74%

“…Hepatofugal flow in the portal vein branches is frequently seen after a successful TIPS and reflects a complete diversion of the portal venous flow from the hepatic parenchyma into the shunt [8,9]. In our experience the conversion of flow from retrograde to antegrade is a late sign of shunt malfunction [4].…”

Section: Functioning Shuntsmentioning

confidence: 82%

“…Stenotic shunts, therefore, usually manifested as decreased shunt velocities. In our experience, we have become more successful in identifying and sampling the stenotic segments of the shunt, and thus, found that stenosed shunts are often manifested by elevated peak shunt velocities [4,17].…”

Section: Compromised Shuntsmentioning

confidence: 99%

“…Primary indications of TIPS included variceal bleeding, refractory ascites, hypertensive gastropathy, and hepatorenal syndrome in patients awaiting liver transplantation [3] or as a rescue procedure when other treatments have failed [2]. However, a major caveat of TIPS is its progressive stenosis leading to a recurrent increase in portal pressure gradient (PPG) or TIPS dysfunction and to the recurrence of gastrointestinal bleeding or ascites [4]. TIPS dysfunction is very frequent, with an incidence up to 80% in the first year as previously reported [5,6] and it is the most common cause of rebleeding in patients treated with TIPS.…”

Section: Introductionmentioning

confidence: 99%

“…To date, Color-Doppler sonography (CDUS) is a commonly used screening modality for the evaluation of TIPS patients, and it is a routine follow-up tool in asymptomatic patients and in patients with clinically suspected TIPS malfunction [1,2,4,8,9]. A number of studies reported a variety of CDUS criteria with very high sensitivity and specificity to detect TIPS dysfunction [10].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Is color-Doppler US a reliable method in the follow-up of transjugular intrahepatic portosystemic shunt (TIPS)?

Ricci

Cantisani

Lombardi

et al. 2007

Journal of Ultrasound

Self Cite

View full text Add to dashboard Cite

KEYWORDSTips; Sonography; Doppler US.Abstract Transjugular intrahepatic portosystemic shunt (TIPS) has become a widely accepted treatment for complications of portal hypertension. Shunt or hepatic vein stenoses or occlusions are common short-and mid-term complications of the procedure, with a oneyear primary patency ranging from 25% to 66%. When promptly identified, shunt stenosis or occlusion may be treated before the recurrence of gastrointestinal bleeding or ascites. The revision is usually successful and the primary-assisted patency of TIPS is approximately 85% at one year.Doppler sonography is a widely accepted screening modality for TIPS patients, both as a routine follow-up in asymptomatic patients and in those cases with clinically suspected TIPS malfunction.In a routine US follow-up, a TIPS patient is scheduled for a control 24 h after the procedure, and then after one week, 1 month, 3 months, and at 3-month intervals thereafter. Venography is at present performed solely on the basis of a suspected shunt dysfunction during the sonographic examination.Color-Doppler sonography is the most reliable method for monitoring the shunt function after TIPS implantation. Several studies have shown that Doppler sonography is a sensitive and relatively specific way to detect shunt malfunction, particularly when multiple parameters are examined. Achieving high sensitivity is optimal so that malfunctioning shunts can be identified and shunt revision can be performed before symptomatic deterioration. Venous angiography is at present indicated only on the basis of US suspicion of shunt compromise. Power-Doppler US and US contrast media can be useful in particular conditions, but are not really fundamental. Sommario La derivazione portosistemica per via percutanea transgiugulare, nota con l'acronimo TIPS, è diventata una modalità di trattamento delle complicanze dell'ipertensione portale. Stenosi od occlusioni dello shunt o delle vene epatiche sono complicanze a breve e medio termine, con pervietà a un anno compresa tra 25% e 66%. Se la diagnosi di stenosi od occlusione è precoce, il trattamento consente di evitare recidiva di ematemesi o ascite. La revisione dello shunt è generalmente di successo e la pervietà assistita della TIPS è di circa il 5% a un anno. Le tecniche Doppler sono ampiamente accettate nelle procedure di screening dei pazienti con TIPS, sia nel paziente asintomatico sia in quello con sospetto clinico di malfunzione dello shunt. In una procedura di follow-up la valutazione color-Doppler viene eseguita dopo 24 ore, dopo 7 giorni, dopo 1 mese, dopo 3 mesi e quindi ogni 3 mesi. La venografia viene oramai effettuata soltanto su precisa indicazione dell'esame ecografico. Il color-Doppler è la metodica migliore per il monitoraggio del funzionamento dello shunt dopo l'impianto di una TIPS. Molti studi hanno dimostrato che il Doppler è sensibile e relativamente specifico nell'identificare la malfunzione dello shunt, particolarmente se molteplici parametri vengono esaminati contemporaneamente. L'elevata sensibil...

show abstract

Section: Functioning Shuntssupporting

confidence: 74%