Value of CT angiography as a non-invasive method to evaluate the patency of TIPSS

Purpose: To evaluate the feasibility of determining patency of the transjug ular intrahepatic portosystemic shunt (TIPSS) by noninvasive CT angiography (CTA). Materials and methods: (1) Non-enhanced scanning of the shunt. (2) Bolus tr acking by injecting 20 ml of non-ionic contrast material through a cubital vein access to determine the time to maximal shunt enhancement. (3) Contras t-enhanced spiral CT study applying a delay according to the time to peak o f the shunt, 3 mm collimation, 5 mm table feed and 3 mm reconstruction inte rval. (4) 3D and multiplanar reconstructions. (5) Evaluation of the questio ns: intrahepatic shunt patent or not; evidence of intimal hyperplasia; evid ence of stenosis and potential location.(6) Transjugular portography via th e stent. (7) Comparison of angiographic findings and CT morphology. Results: Eight patients had inconspicuous CTA. Four of them had a normal sh unt at angiography, four had slight intimal hyperplasia. No intervention wa s necessary in these patients. CTA of three patients showed intimal hyperpl asia (lumen reduction between 10% and 50%). The diagnosis was angiographica lly confirmed in all cases. Due to a high portosystemic gradient interventi on was required in all. In five patients CTA and angiography showed a steno sis (reduction of shunt lumen >50%). All required a revision including sten t placement or PTA of the shunt tract. Four shunts were occluded; all occlu sions were shown both in CTA and angiography. Conclusions: None of the shunts with normal findings at CTA required revisi on. All shunts conspicuous on CTA resulted in revision. In this study, CTA turned out to be an accurate, non-invasive method to evaluate the patency o f TIPSS.