Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jun 27, 2022; 14(6): 1200-1209
Published online Jun 27, 2022. doi: 10.4254/wjh.v14.i6.1200
Use of doppler ultrasound to predict need for transjugular intrahepatic portosystemic shunt revision
Nikki Duong, Marcus Healey, Kunal Patel, Brian J Strife, Richard K Sterling
Nikki Duong, Richard K Sterling, Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University Medical Center, Richmond, VA 23219, United States
Marcus Healey, Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond, VA 23219, United States
Kunal Patel, Brian J Strife, Division of Interventional Radiology, Virginia Commonwealth University Medical Center, Richmond, VA 23219, United States
Author contributions: Duong N and Sterling RK contributed to the design of the study, data analysis, and major edits; Duong N, Healey M and Patel K contributed to data collection; Strife B contributed to major edits of the manuscript; all authors have read and approve the final manuscript.
Institutional review board statement: Study was approved by IRB ( IRB HM20022488).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: No conflicts of interest for all authors.
Data sharing statement: No additional data available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nikki Duong, MD, Academic Fellow, Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University Medical Center, 1200 E Broad Street, Richmond, VA 23219, United States. nduong91@gmail.com
Received: January 30, 2022
Peer-review started: January 30, 2022
First decision: March 25, 2022
Revised: March 28, 2022
Accepted: May 22, 2022
Article in press: May 22, 2022
Published online: June 27, 2022
Abstract
BACKGROUND

Transjugular intrahepatic portosystemic shunt (TIPS) is used to treat complications of portal hypertension, such as ascites and variceal bleeding (VB). While liver doppler ultrasound (DUS) is used to assess TIPS patency, trans-shunt venography (TSV) is the gold standard.

AIM

To determine the accuracy of DUS to assess TIPS dysfunction and for need for revision.

METHODS

Retrospective review of patients referred for TIPS revision from 2008-2021. Demographics, DUS parameters at baseline and at the DUS preceding TIPS revision, TSV data were collected. Receiver operating characteristics curves, sensitivity, specificity, performance for doppler to predict need for revision were performed. Univariate and multivariate analyses were used to predict clinical factors associated with need for TIPS revision.

RESULTS

The cohort consisted of 89 patients with cirrhosis (64% men, 76% white, 31% alcohol as etiology); median age 59 years. Indication for initial TIPS were VB (41%), refractory ascites (51%), and other (8%). TIPS was revised in 44%. On univariate analysis, factors associated with need for TIPS revision were male (P = 0.03), initial indication for TIPS (P = 0.05) and indication for revision (P = 0.01). Revision of TIPS was associated with lower mortality (26% vs 46%) and significantly lower rates of transplant (13% vs 24%; P = 0.1). In predicting need for TIPS revision, DUS has a 40% sensitivity, 45% specificity, PPV 78%, and NPV 14%. The most accurate location for shunt velocity measure was distal velocity (Area under the curve: 0.79; P = 0.0007).

CONCLUSION

DUS has poor overall sensitivity and specificity in predicting need for TIPS revision. Non-invasive methods of predicting TIPS dysfunction are needed since those needing TIPS revision had better survival.

Keywords: Transjugular intrahepatic portosystemic shunt, Doppler ultrasound, Portal hypertension

Core Tip: Transjugular intrahepatic portosystemic shunt (TIPS) is used to treat complications of portal hypertension, however methods to assess TIPS patency are highly variable. Herein, we present a retrospective review of patients referred for TIPS revision from 2008-2021, and demonstrate that doppler ultrasound has poor overall sensitivity and specificity in predicting need for TIPS revision. Non-invasive methods of predicting TIPS dysfunction are needed since those needing TIPS revision had better survival.