Role of ultrasound surveillance of transjugular intrahepatic portosystemic shunts in the covered stent era.
OBJECTIVE
To assess ultrasound (US) surveillance of expanded polytetrafluoroethylene (ePTFE)-covered stents in transjugular intrahepatic portosystemic shunts (TIPS).


METHODS
Procedural data, including stent size and portosystemic gradients (PSG) before and after creation of TIPS, were obtained retrospectively in 55 patients (33 men, 22 women). Chart review provided clinical information, including etiology of liver disease, indication for TIPS creation, and Child-Pugh class. Radiology reports provided US venography data and pathology reports confirmed shunt status in transplant recipients. Patients had baseline US examinations 3-7 days after TIPS creation with scheduled follow-up at 1, 3, 6, and 12 months after the procedure. Clinical and radiology reports were compared to evaluate US surveillance of Viatorr stents.


RESULTS
One hundred fifty-nine US examinations were performed on 52 patients, for an average 3.1 studies per patient (range, 1-7) over a mean follow-up duration of 173 days (range, 0-1,013 d). Sixty-four US studies (40%) were baseline studies, 88 studies (55%) were routine follow-up studies, and seven (4%) were interval studies. US predicted TIPS abnormalities in 30 of 159 studies (19%); venography followed 15 of 30 abnormal US findings (50%) and clinical examinations complemented 10 of 15 venograms (67%). Venography and US were concordant in eight of 15 paired studies (53%); clinical examinations, when conducted, accurately predicted shunt status in all but one case. US findings changed management in six of 159 studies (4%): five of six (83%) were baseline evaluations and the other one (17%) was a routine follow-up examination. A total of five baseline US examinations (8%) and one surveillance examination (1%) altered patient management.


CONCLUSIONS
A single US examination after a TIPS procedure to confirm immediate function may be valuable, but routine US is not effective for long-term surveillance of ePTFE-covered stents.
Carr
Caitlin E
CE
Department of Radiology, Division of Interventional Radiology, University of Pennsylvania Medical Center, 1 Silverstein, 3400 Spruce Street, Philadelphia, 19104, USA.
Tuite
Catherine M
CM
Soulen
Michael C
MC
Shlansky-Goldberg
Richard D
RD
Clark
Timothy W I
TW
Mondschein
Jeffrey I
JI
Kwak
Andrew
A
Patel
Aalpen A
AA
Coleman
Beverly G
BG
Trerotola
Scott O
SO
D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006503:Hepatic Veins / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D006975:Hypertension, Portal / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D011138:Polytetrafluoroethylene; D017082:Portal Pressure; D011169:Portal Vein / Q000000981:diagnostic imaging* / Q000503:physiopathology; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011172:Portography; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D014463:Ultrasonography
D011138:Polytetrafluoroethylene