• Understand the physiology of portal hemodynamics. • Describe portal hemodynamic changes after TIPS placement. • Recognize the ultrasonographic findings of TIPS dysfunction.
TIPS (Transjugular Intrahepatic Portosystemic Shunt) is a procedure that has shown benefit in the treatment of patients with complications derived from portal hypertension. Originally described by Rösch as: “a percutaneous imaging-guided procedure in which a shunt is constructed within the liver with the intent of reducing portal pressure by diverting blood from the portal to the systemic circulation”. 1 Doppler ultrasonography is the first-line method used to evaluate a TIPS procedure,...
Findings and procedure details
The shunt'spatency is often compromised by dysfunction (due to occlusion or stenosis of the intrahepatic or outflow tract). 8 Trans-shunt venography (shunt portography or portogram) continues to be the gold standard for TIPS evaluation.
Nevertheless it is an expensive and invasive procedure.
Doppler ultrasonography is the most common non-invasive technique used to assessTIPS patency.
It is the screening tool of choice todetect early shunt dysfunction. TIPS dysfunction criteria include: >50%...
TIPS is an endovascular portosystemic shunt used to treat complications of portal hypertension (such as hemorrhage or refractory ascites,
amongst others). The use of TIPS in secondary prevention of variceal bleeding and in refractory ascites is supported by high-level evidence. Doppler ultrasonography has a high sensitivity and specificity for the diagnosis of TIPS occlusion.
It is also considered the first-line method for TIPS functional status follow-up.
This includes the pre-placement...
First year Radiology Resident of Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán,
The Transjugular Intrahepatic Portosystemic Shunt: An Update.
AJR 2012;199:746-755 2.
Doppler US of the Liver Made Simple.
RadioGraphics 2011;31(1): 161-188 3.
Transjugular Intrahepatic Portosystemic Shunt versus Endoscopic Therapy in the Secondary Prophylaxis of Variceal Rebleeding in Cirrhotic Patient: Metanalysis Update.
J Clin Gastroenterol 2008;129:1282-1293...