title: Increase in hepatic arterial blood flow after transjugular intrahepatic portosystemic shunt creation and its potential predictive value of postprocedural encephalopathy and mortality.
abstract: OBJECTIVE
  To determine (i) whether there is a significant increase in hepatic artery blood flow (HABF) after transjugular intrahepatic portosystemic shunt (TIPS) creation and (ii) whether the extent of incremental increase in HABF is predictive of clinical outcome after TIPS creation.
  
  
  METHODS
  Prospective, nonrandomized, nonblinded duplex Doppler ultrasound (US) examinations were performed on 24 consecutive patients (19 men; Child Class A/B/C: 4/12/8, respectively) with a mean age of 52.8 years who were referred for TIPS creation for variceal bleeding. Peak hepatic artery velocity and vessel dimensions were used to calculate the hepatic arterial blood flow (HABF) before and after TIPS creation. Patients were clinically followed in the gastrohepatology clinic and TIPS US surveillance was performed at 1 and 3 months to assess shunt function. The extent of incremental increase in HABF was analyzed as a predictor of post-TIPS encephalopathy and/or death.
  
  
  RESULTS
  The technical success rate of TIPS creation was 100%. The shunt diameters were either 10 mm (n = 11) or 12 mm (n = 13). TIPS resulted in a significant reduction in the portosystemic gradient from 24.3 mm Hg +/- 5.7 to 9.3 mm Hg +/- 2.9 (P <.001). The hepatic artery peak systolic velocity and HABF increased significantly after TIPS creation, from 60.8 cm/sec +/- 26.7 to 121 cm/sec +/- 51.5 (P <.001) and from 254.2 mL/min +/- 142.2 to 507.8 mL/min +/- 261.3 (P <.001), respectively. The average incremental increase in HABF from pre-TIPS to post-TIPS was 253.6 mL/min +/- 174.2 and the average decremental decrease in portosystemic gradient was 15.0 mm Hg +/- 5.3, but there was no significant correlation (r = 0.04; P =.86) between the two. All shunts were patent at 30 and 90 days without sonographic evidence of shunt dysfunction. After TIPS creation, new or worsened encephalopathy developed in five patients at 30 days and in an additional three at 90 days. They were all successfully managed medically. Three patients (12.5%) died within 30 days of the TIPS procedure. The extent of incremental increase in HABF after TIPS was variable and did not correlate with the development of 30-day and 90-day encephalopathy (P =.41 and P =.83, respectively) or 30-day mortality (P =.2).
  
  
  CONCLUSIONS
  HABF increases significantly after TIPS but is not predictive of clinical outcome. The significance of the incremental increase is yet to be determined.
authors.affiliation: Department of Radiology, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA. nhpatel@iupui.edu
authors.forename: N H
authors.initials: NH
authors.lastname: Patel
authors.forename: K J
authors.initials: KJ
authors.lastname: Sasadeusz
authors.forename: R
authors.initials: R
authors.lastname: Seshadri
authors.forename: N
authors.initials: N
authors.lastname: Chalasani
authors.forename: H
authors.initials: H
authors.lastname: Shah
authors.forename: M S
authors.initials: MS
authors.lastname: Johnson
authors.forename: J
authors.initials: J
authors.lastname: Namyslowski
authors.forename: K P
authors.initials: KP
authors.lastname: Moresco
authors.forename: S O
authors.initials: SO
authors.lastname: Trerotola
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001783:Blood Flow Velocity; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006499:Hepatic Artery / Q000000981:diagnostic imaging*; D006501:Hepatic Encephalopathy / Q000209:etiology; D006801:Humans; D008107:Liver Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex