Published online Jun 27, 2022. doi: 10.4254/wjh.v14.i6.1200
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
Processing time: 143 Days and 23.5 Hours
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.
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.
To determine the accuracy of doppler ultrasound to assess TIPS dysfunction and for need for revision.
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.
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).
DUS has poor overall sensitivity and specificity in predicting need for TIPS revision.
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.