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DOI: 10.1055/a-2422-8339
Portal vein velocity and its dynamics: a potentially useful tool for detecting clinically silent transjugular intrahepatic porto-systemic shunt dysfunction using Doppler ultrasonography
Dr. Corina Radu was supported by the project New smart and adaptive robotics solutions for personalized minimally invasive surgery in cancertreatment—ATHENA, funded by European Union—NextGenerationEU and Romanian Government, under National Recovery and Resilience Plan for Romania, contract no. 760072/23.05.2023, code CF 116/15.11.2022, through the Romanian Ministry of Research, Innovation and Digitalization, within Component 9, investment I8, Ministry of Research, Innovation andDigitization.
Abstract
Background Ultrasound (US) surveillance for transjugular intrahepatic portosystemic shunt (TIPS) dysfunction has yet to be standardized, as clear-cut criteria have not been conventionally defined. This study evaluated the role of US-based parameters in detecting hemodynamic TIPS dysfunction (HD).
Methods We included consecutive patients treated with TIPS. All patients were scheduled within the first six weeks after the procedure for TIPS revision, comprised of a Doppler US exam and invasive hemodynamic reassessment. Clinical TIPS dysfunction (CD) was defined as symptom recurrence, while HD was defined by a portal pressure gradient (PPG)≥12 mmHg. The predictive capabilities of Doppler US for predicting TIPS dysfunction were tested against the hemodynamic gold standard.
Results 86 patients were included. Secondary prophylaxis of variceal bleeding was the main indication for TIPS in 72 patients (83.7%), while 27 (31.4%) had refractory ascites. HD occurred in 37 cases (43%), of which 25 patients (67.5%) had no CD. Patients with HD had a significantly lower portal vein velocity (PVV): 35 (20–45) cm/s vs. 40.5 (35–50) cm/s, p=0.02. Compared to the immediate post-TIPS assessment, the patients without HD had a ΔPVV of 6.08±19.8 cm/s vs. a decrease of − 8.2±20.2 cm/s in HD (p=0.04). Using a cut-off value of 40.5 cm/s, PVV had an AUROC of 0.705 for predicting HD, while the addition of ΔPVV (cut-off 9.5 cm/s) improved the AUROC to 0.78.
Conclusion Despite adequate symptom control, a considerable percentage of patients have a post-TIPS PPG≥12 mmHg. The dynamic assessment of PVV and its temporal dynamics can reliably predict TIPS dysfunction.
Keywords
shunts - interventional procedures - transjugular intrahepatic porto-systemic shunt - TIPS - Color Doppler ultrasoundPublication History
Received: 20 March 2024
Accepted: 24 September 2024
Article published online:
17 December 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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Rareș Crăciun, Horia Ștefănescu, Oana Nicoară-Farcău, Petra Fischer, Andreea Fodor, Marcel Tanţău, Corina Radu, Zeno Spârchez, Bogdan Procopeţ. Portal vein velocity and its dynamics: a potentially useful tool for detecting clinically silent transjugular intrahepatic porto-systemic shunt dysfunction using Doppler ultrasonography. Ultrasound Int Open 2024; 10: a24228339.
DOI: 10.1055/a-2422-8339