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i
ka1
1ka1ková1
lek2
afka2 Va
ásek2
3
1
Department of Diagnostic Radiology, Charles University Hospital,
Sokolská 408, CZ-500 05 Hradec
Králové, Czech
Republic.
2
Department of Internal Medicine, Charles University Hospital, CZ-500 05 Hradec
Králové, Czech
Republic.
3
Department of Biophysics, Medical Faculty, Charles University, CZ-500 38
Hradec
Králové, Czech
Republic.
OBJECTIVE. The purpose of the study was to evaluate the long-term clinical efficacy of Doppler sonography in revealing failure of transjugular intrahepatic portosystemic shunts (TIPS).
SUBJECTS AND METHODS. During a 5-year period, 1192 Doppler examinations were performed in 216 patients with TIPS. No regular follow-up shunt venography was performed. Doppler examinations were retrospectively compared with the results of shunt revisions. Sonograms with negative findings were compared with the patients' clinical status so that the number of false-negative sonographic findings leading to an episode of shunt failure (recurrence of gastrointestinal bleeding or ascites) could be ascertained. Sonographic parameters assessed included diameter, velocity, flow volume, and congestion index of the portal vein; and shunt velocities.
RESULTS. Doppler sonography revealed shunt occlusion in 25 of 26
angiographically proven cases (sensitivity, 96%). The combination of velocity
criteria (peak intrashunt velocity 
250 cm/sec, maximum velocity in the
portal third of the shunt 
50 cm/sec, or maximum portal vein velocity less
than or equal to two thirds of the baseline value) revealed shunt stenosis in
103 of 110 cases (sensitivity, 94%). Doppler sonography missed a significant
shunt stenosis that led to an episode of gastrointestinal bleeding or ascites
recurrence in only seven cases. The congestion index of the portal vein showed
significant differences between patent and malfunctioning shunts
(p<0.001).
CONCLUSION. Doppler sonography is an effective primary imaging method for long-term follow-up of patients with TIPS.
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