[Evaluation of hepatic encephalopathy and portal hemodynamics by Doppler ultrasonography after a transjugular intrahepatic portosystemic shunt].
TIPS (transjugular intrahepatic portosystemic shunt) is an efficacious treatment for esophagogastric varices, ascites and hypertensive gastrointestinal vasculopathy associated with portal hypertension. The main complication after the procedure is hepatic encephalopathy. We tried to elucidate the correlation between hepatic encephalopathy and changes in portal hemodynamics after TIPS, based on observation by Doppler ultrasonography. We carried out Doppler ultrasonography in 28 cases of TIPS to assess hepatopetal and hepatofugal blood flow in the right and left portal branches. Hepatic encephalopathy occurred after TIPS in 9 cases out of 28 (32%), and new onset of disease was observed in 6 of 9. Doppler ultrasonography revealed hepatofugal blood flow in both right and left portal branches in 6 cases, 5 of which showed encephalopathy. Hepatopetal blood flow of the right and left portal branches was observed in 17 of 28 cases after TIPS. Hepatic encephalopathy occurred in only 2 of 17 cases. The changes in portal vein hemodynamics after TIPS were investigated by color Doppler ultrasonography, which were considered to be very useful for prediction of hepatic encephalopathy and indication of medical treatment to prevent the occurrence of this disease.
Kimura
M
M
Department of Radiology, Wakayama Medical College.
Sato
M
M
Kawai
N
N
Tanihata
H
H
Horihata
K
K
Shioyama
Y
Y
Sonomura
T
T
Yoshikawa
A
A
Kishi
K
K
Terada
M
M
Yamada
R
R
D000328:Adult; D000368:Aged; D005260:Female; D006439:Hemodynamics; D006501:Hepatic Encephalopathy / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery*; D008102:Liver Circulation; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011168:Portal System / Q000000981:diagnostic imaging / Q000503:physiopathology*; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects*; D018615:Ultrasonography, Doppler, Color