[Follow-up with Doppler color ultrasonography of patients treated with transjugular intrahepatic portosystemic diversion].
We investigated both reliability and limitations of color flow duplex US (CFDU) during the preoperative period and in the follow-up of the patients submitted to transjugular intrahepatic portosystemic shunt (TIPS). MATERIAL AND METHODS. Sixty-six patients suffering from cirrhosis underwent TIPS. Twenty-seven patients were excluded from the trial, as they were treated in other hospitals and submitted to different follow-up. Twenty-four hours before and 48 hours after TIPS, and at 3, 6 and 12 months' intervals during the follow-up, the mean flow rate was measured in the main portal vein and in the stent; the reappearance of ascitis was monitored by the same operator with CFDU. Six and 12 months after TIPS, all patients underwent venography and endoscopy. RESULTS. In 25 cases (64%), both CFDU and venography confirmed shunt patency. In these patients, the flow rate in the main portal vein and stent remained constantly high. In 9 patients (23%), CFDU diagnosed a stenosis on the basis of a marked reduction in the mean flow rate in the main portal vein (p < 0.001), which in 2 patients returned to pre-TIPS values, and in the stent proximal to the portal vein (p < 0.001). In 2 patients (5%), the obstruction was characterized by a return to pre-TIPS values in the portal vein and by the absence of any flow in the stent. Velocimetric sampling in the stent proximal to the vena cava had poor statistical significance. Venography confirmed the flowmetric results in all but 3 patients (7%). CONCLUSIONS. On the basis of our data, CFDU exhibited about 100% sensitivity, 89% specificity and 92% accuracy in the diagnosis of TIPS stenosis/obstruction. We therefore consider CFDU a useful tool in the follow-up of the patients submitted to TIPS, angiography being suggested only when needed on the basis of CFDU and/or endoscopic findings.
Pancione
L
L
Servizio di Radiodiagnostica, Ospedale Civile S. Paolo, Savona.
Ballotto
L
L
Lupo
F
F
Seghetto
G
G
Orio
O
O
Perno
G
G
Ferro
C
C
D005500:Follow-Up Studies; D006801:Humans; D007601:Jugular Veins; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D011170:Portasystemic Shunt, Surgical / Q000379:methods*; D015203:Reproducibility of Results; D018615:Ultrasonography, Doppler, Color
Il follow-up con eco color Doppler dei pazienti sottoposti a derivazione intraepatica portosistemica per via transgiugulare (TIPS).