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Value of Doppler Sonography in Revealing Transjugular Intrahepatic Portosystemic Shunt Malfunction

A 5-Year Experience in 216 Patients

Jan ika¹, Pavel Eliá¹, Antonín Krajina¹, Antonín Michl¹, Miroslav Lojík¹, Pavel Ryka¹, Jana Maková¹, Petr Hlek², Václav afka², Tomá Vaásek² and Josef Buka³

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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