DOPPLER SONOGRAPHY IN SHORT-TERM AND LONG -TERM PORTAL HEMODYNAMIC EVALUATION AFTER TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC STENT-SHUNT [TIPS]

Shunt insufficiency due to shunt occlusion or stenosis is frequent aft er TIPS (about 50% after one year), Controversially discussed is wheth er Doppler sonography is effective in detecting shunt stenosis or whet her regular angiographies are required. The experience with a noninvas ive method of surveillance primarily based on Doppler sonography is re ported here. 58 patients (35 men, 23 women, mean age 55 years, range 3 3-82 years) were treated by TIPS because of complications of portal hy pertension (43 x gastroesophageal bleeding, 14 x refractory ascites, 1 x venoocclusive disease). Liver cirrhosis (alcoholtoxic etiology in 6 3%) was present in 55 cases, according to Child-Pugh's classification 23 patients = A, 19 patients = B and 13 patients = C, Within a mean ob servation period of 14 months, Doppler sonography was performed in thr ee months intervals, endoscopy in six months intervals and angiography only when shunt insufficiency was suspected by Doppler sonography and /or because of clinical events, e. g. recurrent bleeding. Immediately after TIPS, maximal flow velocity, and flow volume in the portal vein increased by 116% and 115%, respectively. Three months later, a signif icant increase of portal vein diameter of about 15% was measured. Shun t flow was initially 2.700 ml/min (one week after TIPS) and decreased progressively by about 30% within the first nine months of follow-up. Correspondingly, angiographically proven shunt insufficiency was prese nt in 22 patients (33 episodes). A total of twelve bleeding episodes r ecurred in seven patients (rebleeding rate of 16% after one year and 1 9% after two years). In the remaining 15 patients (68%; 21 episodes) s hunt insufficiency could be corrected prior to complications because o f detection by Doppler sonography (19 x) and endoscopy (2 x). Therefor e, Doppler sonography is an effective diagnostic tool for the detectio n of shunt insufficiency and should be performed at three months inter vals for at least 18 months. In this context it appears allowable to a void routine angiographies.