Increase in hepatic arterial blood flow after transjugular intrahepatic portosystemic shunt creation and its potential predictive value of postprocedural encephalopathy and mortality

PURPOSE: To determine (i) whether there is a significant increase in hepati c artery blood flow (HABF) after transjugular intrahepatic portosystemic sh unt (TIPS) creation and GO whether the extent of incremental increase in HA BF is predictive of clinical outcome after TIPS creation. MATERIALS AND METHODS: Prospective, nonrandomized, nonblinded duplex Dopple r ultrasound (US) examinations were performed on 24 consecutive patients (1 9 men; Child Class A/B/C: 4/12/8, respectively) with a mean age of 52.8 yea rs who were referred for TIPS creation for variceal bleeding. Peak hepatic artery velocity and vessel dimensions were used to calculate the hepatic ar terial blood flow (HABF) before and after TIPS creation. Patients were clin ically followed in the gastrohepatology clinic and TIPS US surveillance was performed at 1 and 3 months to assess shunt function. The extent of increm ental increase in HABF was analyzed as:a predictor of post-TIPS encephalopa thy and/or death. RESULTS: The technical success rate of TIPS creation was 100%. The shunt di ameters were either 10 mm (n = 11) or 12 mm (n = 13). TIPS resulted in a si gnificant reduction in the portosystemic gradient from 24.3 mm Hg +/- 5.7 t o 9.3 mm Hg +/- 2.9 (P < .001). The hepatic artery peak systolic velocity a nd HABF increased significantly after TIPS creation, from 60.8 cm/sec +/- 2 6.7 to 121 cm/sec +/- 51.5 (P < .001) and from 254.2 mL/min +/- 142.2 to 50 7.8 mL/min +/- 261.3 (P < .001), respectively. The average incremental incr ease in HABF from pre-TIPS to post-TIPS was 253.6 mL/min +/- 174.2 and the average decremental decrease in portosystemic gradient was 15.0 mm Hg +/- 5 .3, but there was no significant correlation (r = 0.04; P = .86) between th e two. All shunts were, patent at 30 and 90 days without sonographic eviden ce of shunt dysfunction. After TIPS creation, new or worsened encephalopath y developed in five patients at 30 days and in an additional three at 90 da ys. They were all successfully managed medically. Three patients (12.5%) di ed within 30 days of the TIPS procedure. The extent of incremental increase in HABF after TIPS was variable and did not correlate with the development of 30-day and 90-day encephalopathy (P = .41 and P = .83, respectively) or 30-day mortality (P = .2). CONCLUSIONS: HABF increases significantly after TIPS but is not predictive of clinical outcome. The significance of the incremental increase is yet to be determined.