Duong N, Healey M, Patel K, Strife BJ, Sterling RK. Use of doppler ultrasound to predict need for transjugular intrahepatic portosystemic shunt revision. World J Hepatol 2022; 14(6): 1200-1209 [PMID: 35978660 DOI: 10.4254/wjh.v14.i6.1200]
Corresponding Author of This Article
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
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
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
ARTICLE HIGHLIGHTS
Research background
Portal hypertension as a result of cirrhosis can lead to complications such as variceal bleeding and ascites. Refractory variceal bleeding or ascites can be treated with Transjugular intrahepatic portosystemic shunt (TIPS), an expandable polytetrafluoroethylene covered stent used to decrease portal pressures. However, a complication of this procedure is stent stenosis.
Research motivation
There are currently no guidelines to assist providers in ensuring TIPS patency. Our study aims to assess the accuracy of doppler ultrasound in predicting need for TIPS revision, compared to trans-shunt venography (TSV) as the gold standard.
Research objectives
To determine the accuracy of doppler ultrasound to assess TIPS dysfunction and for need for revision.
Research methods
Retrospective chart review of patients referred for TIPS revision from 2008-2021 at a tertiary medical center. We collected demographical data, doppler ultrasound (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.
Research results
The cohort consisted of 89 patients with cirrhosis (64% men, 76% white, 31% alcohol as etiology); median age 59 years. 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 (AUC 0.79; P = 0.0007).
Research conclusions
DUS has poor overall sensitivity and specificity in predicting need for TIPS revision.
Research perspectives
Future research should include multi-center prospective trials using our proposed cut-off of a distal shunt velocity of less than 114 cm/second, to determine if this is the optimal cut-off to predict need for TIPS revision.
