Hepatic perfusion before and after the transjugular intrahepatic portosystemic shunt procedure: impact on survival.
OBJECTIVE
This study correlates transjugular intrahepatic portosystemic shunt (TIPS) mortality with flow patterns in the cirrhotic liver.


METHODS
Twenty-seven TIPS patients and 10 control subjects were used for this study. The authors evaluated hepatic perfusion with venous injections of Tc-99m pertechnetate before and after TIPS. Hepatic time-activity curves were analyzed for type and amount of liver perfusion. These parameters were correlated with survival for a mean follow-up of 18 months.


RESULTS
The mean arterial contribution to liver blood flow was 25.4% in the normal control patients, 39.9% in patients prior to TIPS, and increased to 48.3% after TIPS. Although the proportion of arterial supply to the cirrhotic liver varied widely, TIPS mortality did not correlate with the preprocedure hepatic artery/portal venous perfusion ratio. However, patients with both an "arterialized" flow pattern and low total hepatic perfusion had higher mortality, with a mean survival of 2 months compared to patients with a more favorable perfusion profile (mean survival, 28.4 months).


CONCLUSIONS
The proportion of arterial perfusion to the liver before TIPS did not affect survival. However, patients with a combination of reduced total hepatic perfusion and an arterial flow pattern had poorer survival, suggesting that both the quantity and quality of hepatic perfusion predicts TIPS outcome.
Walser
E M
EM
Department of Radiology, University of Texas Medical Branch, Galveston 77555-0709, USA. emwalser@utmb.edu
DeLa Pena
R
R
Villanueva-Meyer
J
J
Ozkan
O
O
Soloway
R
R
D000704:Analysis of Variance; D005500:Follow-Up Studies; D005544:Forecasting; D006499:Hepatic Artery / Q000503:physiopathology; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging; D008102:Liver Circulation / Q000502:physiology*; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D011169:Portal Vein / Q000503:physiopathology; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D015642:Radiology, Interventional; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012039:Regional Blood Flow / Q000502:physiology; D012044:Regression Analysis; D012079:Renal Circulation / Q000502:physiology; D013670:Sodium Pertechnetate Tc 99m; D013154:Spleen / Q000098:blood supply; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
D019275:Radiopharmaceuticals; D013670:Sodium Pertechnetate Tc 99m