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.
Department of Radiology, University of Texas Medical Branch, Galveston 77555-0709, USA. emwalser@utmb.edu
E M
EM
Walser
R
R
DeLa Pena
J
J
Villanueva-Meyer
O
O
Ozkan
R
R
Soloway
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