Value of Doppler sonography in revealing transjugular intrahepatic portosystemic shunt malfunction: A 5-year experience in 216 patients

OBJECTIVE. The purpose of the study was to evaluate the long-term clinical efficacy of Doppler sonography in revealing failure of transjugular intrahe patic portosystemic shunts (TIPS). SUBJECTS AND METHODS. During a 5-year period, 1192 Doppler examinations wer e performed in 216 patients with TIPS. No regular follow-up shunt venograph y was performed. Doppler examinations were retrospectively compared with th e results of shunt revisions. Sonograms with negative findings were compare d with the patients' clinical status so that the number of false-negative s onographic findings leading to an episode of shunt failure (recurrence of g astrointestinal bleeding or ascites) could be ascertained. Sonographic para meters assessed included diameter, velocity, flow volume, and congestion in dex of the portal vein; and shunt velocities. RESULTS. Doppler sonography revealed shunt occlusion in 25 of 26 angiograph ically proven cases (sensitivity, 96%). The combination of velocity criteri a (peak intrashunt velocity greater than or equal to 250 cm/sec, maximum ve locity in the portal third of the shunt less than or equal to 50 cm/sec, or maximum portal vein velocity less than or equal to two thirds of the basel ine value) revealed shunt stenosis in 103 of 110 cases (sensitivity, 94%). Doppler sonography missed a significant shunt stenosis that led to an episo de of gastrointestinal bleeding or ascites recurrence in only seven cases. The congestion index of the portal vein showed significant differences betw een patent and malfunctioning shunts (p < 0.001). CONCLUSION. Doppler sonography is an effective primary imaging method for l ong term follow-up of patients with TIPS.