Doppler sonography findings associated with transjugular intrahepatic portosystemic shunt malfunction.

Kanterman, R Y; Darcy, Michael D.; Middleton, W D; Sterling, Keith M.; Teefey, Sharlene A.; Pilgram, T K

doi:10.2214/ajr.168.2.9016228

Cited by 110 publications

(91 citation statements)

References 13 publications

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“…Based on the first assumption, investigators have attempted to establish a lower limit of normal shunt velocity (Table I) (12,18). On the contrary, several other studies failed to reproduce these good results (20,(22)(23)(24)(25). In order to increase the sensitivity of this parameter, Kanterman et al even propose a lower velocity limit of 90 cm/s (20).…”

Section: Stent Velocitymentioning

confidence: 99%

“…On the contrary, several other studies failed to reproduce these good results (20,(22)(23)(24)(25). In order to increase the sensitivity of this parameter, Kanterman et al even propose a lower velocity limit of 90 cm/s (20). Nonetheless, this involves a huge loss of specificity leading to unnecessary invasive portal angiography.…”

Section: Stent Velocitymentioning

confidence: 99%

“…There is a velocity gradient between the portal and venous side of the TIPS. The mean velocity has been reported as 95 cm/s near the portal side and 120 cm/s in the middle segment of the shunt (18)(19)(20). Immediately after TIPS creation, spectral DUS shows venous pulsatility within the stent and the portal vein (18,21).…”

Section: Stent Velocitymentioning

confidence: 99%

“…Colour DUS shows absence of flow in the lumen of the stent with sensitivity and specificity of approximately 100% (12,17,20). On the other hand, the accuracy of DUS in detecting stenosis is controversial.…”

Section: Tips Malfunctionmentioning

confidence: 99%

“…However, when evaluating the stent, the Doppler scale should be increased (17). or resistance index between normal and abnormal shunts (20).…”

Section: Sonographic Techniquementioning

confidence: 99%

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Sonographic evaluation of transjugular intrahepatic porto-systemic shunt

Thijs

Bielen

et al. 2013

Journal of the Belgian Society of Radiology

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The purpose of this article is to review the role of sonography before, during and after transjugular intrahepatic portosystemic shunt placement. A sonographic assessment of the liver and abdomen is recommended before the procedure. We illustrate several important sonographic findings for the echographist, which may alter the procedure approach or even preclude transjugular intrahepatic portosystemic shunt placement. The most challenging step during the procedure is the puncture of the right portal vein. Sonography can be a helpful tool in reducing the number of needle passes, thereby reducing the risk of hemorrhagic complications. Because of its non-invasive and costbenefit nature, sonography is useful for transjugular intrahepatic portosystemic shunt follow-up. A baseline study at 24 to 48 hours is recommended to discover procedure-related complications. Long-term follow-up is important to detect malfunction of the shunt. Doppler ultrasound is very accurate in detecting shunt thrombosis. however, no consensus exists on the optimal sonographic screening protocol for detecting stenosis. We describe three sonographic parameters to detect transjugular intrahepatic portosystemic shunt stenosis with high sensitivity. finally, additional sonographic parameters and potential pitfalls are provided in order to improve sensitivity.

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