Is sonographic surveillance of polytetrafluoroethylene-covered transjugular intrahepatic portosystemic shunts (TIPS) necessary? A single centre experience comparing both types of stents

Pan, J.-J.; Chen, C.; Geller, B.; Firpi, R.; Machicao, V.I.; Caridi, J.G.; Nelson, D.R.; Morelli, G.

doi:10.1016/j.crad.2008.04.016

« Previous Next »Clinical Radiology
Volume 63, Issue 10 , Pages 1142-1148, October 2008

Is sonographic surveillance of polytetrafluoroethylene-covered transjugular intrahepatic portosystemic shunts (TIPS) necessary? A single centre experience comparing both types of stents

J.-J. Pan
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Section of Hepatobiliary Disease, University of Florida, Gainesville, FL, USA
C. Chen
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Section of Hepatobiliary Disease, University of Florida, Gainesville, FL, USA
B. Geller
- Department of Radiology, University of Florida, Gainesville, FL, USA
R. Firpi
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Section of Hepatobiliary Disease, University of Florida, Gainesville, FL, USA
V.I. Machicao
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Section of Hepatobiliary Disease, University of Florida, Gainesville, FL, USA
J.G. Caridi
- Department of Radiology, University of Florida, Gainesville, FL, USA
D.R. Nelson
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Section of Hepatobiliary Disease, University of Florida, Gainesville, FL, USA
G. Morelli
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Section of Hepatobiliary Disease, University of Florida, Gainesville, FL, USA
- Guarantor and correspondent: G. Morelli, Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, 1600 SW Archer Road, Room M440, Gainesville, FL 32610, USA. Tel.: +1 352 392 7353; fax: +1 352 392 7393.

Received 31 December 2007; received in revised form 27 March 2008; accepted 1 April 2008.

Aim

To investigate whether sonographic (US) surveillance of polytetrafluoroethylene covered transjugular intrahepatic portosystemic shunts (TIPS) is necessary.

Materials and methods

We identified 128 patients who underwent TIPS for complications of portal hypertension between January 2001 and December 2005 at a large tertiary centre. Procedural data were retrospectively analysed. US surveillance of the TIPS was performed at baseline with scheduled follow-up or whenever shunt dysfunction was suspected. Clinical and radiology reports were compared to assess US surveillance of the TIPS.

Results

Four hundred and twenty-six US studies were performed, with a median of three per patient (range 1–5). The median follow-up period was 378 days (range 1–1749 days). Twenty-three patients (18%) had baseline US studies performed only whereas 105 (82%) also had follow-up studies. Forty-one (32%) of 128 patients [32 (78%) Wallstent, nine (22%) Viatorr] had Doppler ultrasound abnormalities noted. Venography was performed in all 41 patients. Abnormal venography and elevated hepatic venous pressure gradient (HVPG) was seen in 34 (82.9%) of the 41 patients [29 (85.3%) Wallstent, five (14.7%) Viatorr]. Among the 34 patients, 17 (50%) [13 (76.5%) Wallstent, four (23.5%) Viatorr] had venographic abnormalities noted at the hepatic venous end accompanied by increased HVPG. All four of the Viatorr patients had minor narrowing at the hepatic venous end and HVPG measurements that ranged 3–4mmHg above 12mmHg.