Hepatic and splanchnic perfusion and oxygenation after transjugular intrahepatic portosystemic shunt

OBJECTIVE: in patients with cirrhosis, transjugular intrahepatic portosyste mic shunt (TIPS) decreases the pressure in the portal Vein by rerouting nea rly all the portal blood flow to the systemic circulation. This may lead to hypoper-fusion of the liver and worsening function. Our aim was to investi gate whether TIPS actually reduced hepatic and splanchnic perfusion. METHODS: we studied 25 patients who required placement of a TIPS (20 for va riceal bleeding and 5 for refractory ascites). We evaluated the clinical co ndition, laboratory results, blood velocity in the portal Vein and hepatic artery by echo-Doppler ultrasonography, systemic hemodynamic-oxygenation st atus and hemodynamic-oxygenation status in the pori:al and suprahepatic vei ns before TIPS, 15 min after the procedure, and 30 days later. Hepatic and splanchnic perfusion were evaluated as the arteriovenous difference in O-2 content and as the O-2 extraction rates in the hepatic and splanchnic terri tories. RESULTS: TIPS induced an immediate decrease in portal pressure, a significa nt increase in systemic hyperdynamic state, and an increase in blood flow v elocity in the portal vein and hepatic artery. Thirty days after the proced ure these changes persisted, although they were somewhat attenuated. Althou gh splanchnic and liver perfusion were not changed 15 min or 30 days after TIPS, there was a slight tendency toward a decrease in liver perfusion duri ng follow-up. CONCLUSIONS: TIPS increased the hyperdynamic stale in the systemic side. Ho wever, portal blood shunting did not change liver or splanchnic perfusion.