Use of doppler ultrasound to predict need for transjugular intrahepatic portosystemic shunt revision

Table 2 Comparison of those who underwent transjugular intrahepatic portosystemic shunt revision

Characteristic	Yes revision (n = 39)	No revision (n = 50)	P value
Age	56.7 (12)	57.3 (7.6)
% male/female	51/49	74/26	0.0266
% White/Black/other	72/23/5	80/18/2
Etiology of liver disease %			0.08
EtOH	26	36
HCV	11	20
NASH	21	20
Indication for TIPS %			0.05
VB	53	50
Refractory ascites	34	46
MELD at initial TIPS	15.8 (6.5)	17.2 (5.8)
PSG before TIPS mmHg	15.9 (5.1)	15.1 (4.0)
PSG after TIPS mmHg	5.89 (3.1)	6.3 (2.1)
TIPS dilation mm	8.6 (1.04)	8.2 (0.76)
Days to TIPS revision	572 (740)	466 (612)
Indication for revision (% doppler)	84	59	0.006
MELD at revision	15.5 (6.8)	18.7 (6.5)	0.03
Revision indication	84 [flow issue]	66 [clinical]	.04
Doppler abnormal %	78 [> 5% change proximal flow]	86 [< 5% change]	0.39
High vel/low vel/clinical %	23/51/23	46/16/36	0.0028
DF at revision Doppler prox cm/s	103 (64)	134 (21)	0.0356
DF at revision Doppler mid	109 (92)	151 (52)	0.017
DF at revision Doppler distal	86.6 (72)	174 (105)	0.0003
TIPS occluded %	23	2	0.0019
DF pre-TIPS baseline prox cm/s	112 (50)	133 (36)	0.044
DF pre-TIPs baseline mid	125 (52)	140 (32)	0.16
DF pre-TIPS baseline distal	117 (58)	136 (45)	0.13
Change prox	42 (37)	47 (36)
% change prox	-0.11 (0.42)	0.10 (0.49)
Change mid	69 (69)	46 (30)	0.1
% change mid	-0.057 (0.69)	0.16 (0.51)	0.17/.05 (Wilcoxon)
Change distal	62.9 (51)	73 (89)
% change distal	-0.20 (0.76)	0.32 (0.92)	0.021/0.0014 (Wilcoxan)
PSG pre TIPS revision mmHg	15.5 (6.1)	13.1(14.8)
PSG after TIPS revision mmHg	8.11 (4.3)	8.46 (3.3)
Outcome (Alive/LT/Dead) %	61/13/26	40/14/46	0.1
TIPS stenosis (Y) %	100	46	< 0.0001

DF: Doppler flow; HCV: Hepatitis C virus; NASH: Non-alcoholic steatohepatitis; TIPS: Transjugular intrahepatic portosystemic shunt; VB: Variceal bleeding; MELD: Model for End-Stage Liver Disease; PSG: Porto-systemic gradient.