QUANTIFICATION OF INTRAHEPATIC PORTOSYSTEMIC SHUNTING AFTER PLACEMENTOF A TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT

PURPOSE: To quantify portosystemic shunting and hepatic portal perfusi on after placement of a transjugular intrahepatic portosystemic shunt (TIPS). MATERIALS AND METHODS: Technetium-99m macroaggregated albumin (MAA) was injected directly into the portal veins of nine asymptomatic patients 3 months after TIPS placement, Portosystemic shunting was qu antified by comparing counts in the lungs with those in the liver, One cirrhotic patient and one healthy patient who received portal MAA inj ections were used as controls. RESULTS: No portosystemic shunting was found in the healthy patient, In the cirrhotic control patient, 77% of the injected activity was in the lungs, Patients with portosystemic s hunts had even more activity in the lungs, Even stenotic shunts divert ed greater than 80% of portal blood flow systemically, Flow through th e TIPS ranged from 84% to 100% (average, 93%); these fractions of flow correlated inversely with portosystemic pressure gradients. CONCLUSIO N: Cirrhotic livers may divert much of the portal blood systemically b efore TIPS placement, Afterward, this proportion rises, and most porta l flow is diverted into the pulmonary circulation.