Hepatic and splanchnic perfusion and oxygenation after transjugular intrahepatic portosystemic shunt.
OBJECTIVE
in patients with cirrhosis, transjugular intrahepatic portosystemic shunt (TIPS) decreases the pressure in the portal vein by rerouting nearly all the portal blood flow to the systemic circulation. This may lead to hypoperfusion of the liver and worsening function. Our aim was to investigate whether TIPS actually reduced hepatic and splanchnic perfusion.


METHODS
we studied 25 patients who required placement of a TIPS (20 for variceal bleeding and 5 for refractory ascites). We evaluated the clinical condition, laboratory results, blood velocity in the portal vein and hepatic artery by echo-Doppler ultrasonography, systemic hemodynamic-oxygenation status and hemodynamic-oxygenation status in the portal and suprahepatic veins before TIPS, 15 min after the procedure, and 30 days later. Hepatic and splanchnic perfusion were evaluated as the arteriovenous difference in O2 content and as the O2 extraction rates in the hepatic and splanchnic territories.


RESULTS
TIPS induced an immediate decrease in portal pressure, a significant increase in systemic hyperdynamic state, and an increase in blood flow velocity in the portal vein and hepatic artery. Thirty days after the procedure these changes persisted, although they were somewhat attenuated. Although splanchnic and liver perfusion were not changed 15 min or 30 days after TIPS, there was a slight tendency toward a decrease in liver perfusion during follow-up.


CONCLUSIONS
TIPS increased the hyperdynamic state in the systemic side. However, portal blood shunting did not change liver or splanchnic perfusion.
Cervera
M
M
Unidad de Ciudados Intensivos, Hospital Universitario "Dr. Peset", Valencia, 46017, España.
Añón
R
R
Palmero
J
J
Martínez
J
J
Garcés
R
R
Ripollés
T
T
Moreno-Osset
E
E
Alamán
G
G
Antón
M
M
D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery*; D008102:Liver Circulation; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D013152:Splanchnic Circulation