Is color-Doppler US a reliable method in the follow-up of transjugular intrahepatic portosystemic shunt (TIPS)?

Background: In patients with liver cirrhosis, transjugular intrahepatic portosystemic shunt (TIPS) displays an effective method for treating portal hypertension. Main indications include refractory ascites and secondary prevention of esophageal bleeding. Color Doppler ultrasound (CDUS) plays a leading role in the follow-up management, whereas contrast-enhanced ultrasound (CEUS) is not routinely considered. We compared the efficacy of CEUS to CDUS and highlighted differences compared to findings of corresponding computed tomography (CT) and magnetic resonance imaging (MRI). (2) Methods: On a retrospective basis, 106 patients with CEUS examination after TIPS were included. The enrollment period was 12 years (between 2008 and 2020) and the age group ranged from 23.3 to 82.1 years. In addition, 92 CDUS, 43 CT and 58 MRI scans were evaluated for intermodal comparison. (3) Results: Intermodal analysis and comparison revealed a high level of concordance between CDUS, CT and MRI in the vast majority of cases. In comparison to CDUS, the correlation of the relevant findings was 92.5%, 95.3% for CT and 87.9% for MRI. In some cases, however, additional information was provided by CEUS (4) Conclusions: CEUS depicts a safe and effective imaging modality for follow-up after TIPS. In addition to CDUS, CEUS enables specific assessment of stent pathologies and stent dysfunction due to its capacity to dynamically visualize single microbubbles at high spatial and temporal resolution. Due to the low number of adverse events regarding the application of contrast agents, CEUS can be administered to a very broad patient population, thus avoiding additional radiation exposure compared to CT angiography in cases with divergent findings during follow-up.

Download Full-text

Cardiovascular magnetic resonance demonstrates structural cardiac changes following transjugular intrahepatic portosystemic shunt

Scientific Reports ◽

10.1038/s41598-021-92064-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ulf K. Radunski ◽

Johannes Kluwe ◽

Malte Klein ◽

Antonio Galante ◽

Gunnar K. Lund ◽

...

Keyword(s):

Liver Cirrhosis ◽

Cardiovascular Magnetic Resonance ◽

Magnetic Resonance ◽

Transjugular Intrahepatic Portosystemic Shunt ◽

Troponin T ◽

Left Ventricular ◽

Portosystemic Shunt ◽

Native T1 ◽

Intrahepatic Portosystemic Shunt

AbstractTransjugular intrahepatic portosystemic shunt (TIPS) reduces portal hypertension in patients with liver cirrhosis. The exact cardiac consequences of subsequent increase of central blood volume are unknown. Cardiovascular magnetic resonance (CMR) imaging is the method of choice for quantifying cardiac volumes and ventricular function. The aim of this study was to investigate effects of TIPS on the heart using CMR, laboratory, and imaging cardiac biomarkers. 34 consecutive patients with liver cirrhosis were evaluated for TIPS. Comprehensive CMR with native T1 mapping, transthoracic echocardiography, and laboratory biomarkers were assessed before and after TIPS insertion. Follow-up (FU) CMR was obtained in 16 patients (47%) 207 (170–245) days after TIPS. From baseline (BL) to FU, a significant increase of all indexed cardiac chamber volumes was observed (all P < 0.05). Left ventricular (LV) end-diastolic mass index increased significantly from 45 (38–51) to 65 (51–73) g/m2 (P = < 0.01). Biventricular systolic function, NT-proBNP, high-sensitive troponin T, and native T1 time did not differ significantly from BL to FU. No patient experienced cardiac decompensation following TIPS. In conclusion, in patients without clinically significant prior heart disease, increased cardiac preload after TIPS resulted in increased volumes of all cardiac chambers and eccentric LV hypertrophy, without leading to cardiac impairment during follow-up in this selected patient population.

Download Full-text

TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT (TIPS): LONG TERM FOLLOW-UP ON 4 PATIENTS.

Shock ◽

10.1097/00024382-199606002-00066 ◽

1996 ◽

Vol 5 ◽

pp. 21

Author(s):

C. Groves ◽

P. Malloy ◽

S. O. Pais

Keyword(s):

Transjugular Intrahepatic Portosystemic Shunt ◽

Portosystemic Shunt ◽

Long Term Follow Up ◽

Intrahepatic Portosystemic Shunt

Download Full-text

Early and long-term clinical and radiological follow-up results of expanded-polytetrafluoroethylene-covered stent-grafts for transjugular intrahepatic portosystemic shunt procedures

European Radiology ◽

10.1007/s00330-004-2359-4 ◽

2004 ◽

Vol 14 (10) ◽

Cited By ~ 43

Author(s):

Geert Maleux ◽

Frederik Nevens ◽

Alexander Wilmer ◽

Sam Heye ◽

Chris Verslype ◽

...

Keyword(s):

Transjugular Intrahepatic Portosystemic Shunt ◽

Covered Stent ◽

Portosystemic Shunt ◽

Stent Grafts ◽

Expanded Polytetrafluoroethylene ◽

Intrahepatic Portosystemic Shunt

Download Full-text

Hepatopulmonary Syndrome Successfully Treated with Transjugular Intrahepatic Portosystemic Shunt: A Three-year Follow-up

Journal of Vascular and Interventional Radiology ◽

10.1097/01.rvi.0000127885.68272.e9 ◽

2004 ◽

Vol 15 (6) ◽

pp. 647-648 ◽

Cited By ~ 22

Author(s):

Patrick Chevallier ◽

Luigi Novelli ◽

Jean-Paul Motamedi ◽

Patrick Hastier ◽

Philippe Brunner ◽

...

Keyword(s):

Transjugular Intrahepatic Portosystemic Shunt ◽

Hepatopulmonary Syndrome ◽

Portosystemic Shunt ◽

Intrahepatic Portosystemic Shunt

Download Full-text

Transjugular Intrahepatic Portosystemic Shunt for Hepatic Sinusoidal Obstruction Syndrome Associated with Consumption of Gynura Segetum

10.21203/rs.3.rs-36169/v1 ◽

2020 ◽

Author(s):

Lijie Zhang ◽

Qing Li ◽

Joyman Makamure ◽

Dan Zhao ◽

Ziyi Liu ◽

...

Keyword(s):

Transjugular Intrahepatic Portosystemic Shunt ◽

Total Bilirubin ◽

Portosystemic Shunt ◽

Sinusoidal Obstruction Syndrome ◽

Liver Size ◽

Hepatic Sinusoidal Obstruction Syndrome ◽

Intrahepatic Portosystemic Shunt ◽

Vein Diameter ◽

Lost To Follow Up

Abstract Background: To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) on hepatic sinusoidal obstruction syndrome (HSOS) associated with consumption of Gynura segetum (GS).Methods: We retrospectively reviewed 9 consecutive patients with GS-related HSOS who were refractory to supportive treatment and underwent TIPS at our institution between January 2014 and September 2019. The patients were evaluated for safety and efficacy, including TIPS complications and changes in portosystemic pressure gradient (PPG), ascites, total bilirubin, liver size and portal vein diameter.Results: TIPS procedures were performed successfully in the 9 patients, without any TIPS technique-related complications. The PPG was improved by TIPS in all patients (mean PPG before TIPS, 30.4 ± 5.2 vs. 13.0 ± 4.1 mm Hg post-TIPS, P=0.008). Except for one patient who was lost to follow-up, the remaining 8 patients survived with a median follow-up period of 12 months (range, 5-39 months). Although the level of total bilirubin was significantly increased 5-7 days after TIPS compared with that before the procedure (3.57 ± 1.58 vs. 4.82 ± 2.06 mg/dl, P=0.017), it returned to baseline level at 1-month follow-up (3.53 ± 2.72 vs. 4.82 ± 2.06 mg/dl, P=0.401). The patients experienced complete resolution or obvious reduction of ascites (P<0.001), significant reduction of liver size (16.7 ± 2.2 vs. 13.7 ± 1.7 cm, P=0.018), and significant enlargement of the portal trunk (10.7 ± 2.5 vs. 13.4 ± 2.4 mm, P=0.017) after TIPS compared to the pre-TIPS state.Conclusion: TIPS may offer a potentially useful treatment for the GS-related HSOS.

Download Full-text