Use of doppler ultrasound to predict need for transjugular intrahepatic portosystemic shunt revision

doi:10.4254/wjh.v14.i6.1200

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Jun 27, 2022 (publication date) through Feb 14, 2025

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World Journal of Hepatology

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1948-5182

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Hepatol. Jun 27, 2022; 14(6): 1200-1209
Published online Jun 27, 2022. doi: 10.4254/wjh.v14.i6.1200

Table 1 Characteristics of the cohort

Characteristics	Mean (SD)	Median (IQR)
Age (n = 89)	56.5 (9.8)	59 (51-62)
% male	64
% White/Black/other	76/18/3
Etiology of Liver disease %
EtOH	31
HCV	16
NASH	20
Other	30
Indication for TIPS %
VB	41
Refractory ascites	51
other	8
MELD at initial TIPS	16.6 (6.1)
PSG before TIPS mmHg	15.5 (4.5)	15 (12.5-18)
PSG after TIPS mmHg	6.17 (2.54)	6 (4-8)
TIPS dilation mm	8.41 (0.91)
TIPS revision (d)	514 (670)	311 (54-661)
Indication for revision (% doppler)	74
MELD at revision	17.3 (6.8)
Doppler abnormal %	82
High vel/low vel/clinical %	36/31/30
Doppler flow at revision Doppler prox cm/s	122 (58)	127 (77-169)
Doppler flow at revision doppler mid	135 (73)	140 (77-185)
Doppler flow at revision Doppler distal	141 (103)	122 (57-205)
TIPS occluded %	10
Doppler flow pre-TIPS baseline prox cm/s	125 (43)	122 (100-146)
Doppler flow pre-TIPs baseline mid	133 (42)	140 (109-161)
Doppler flow pre-TIPS baseline distal	128 (52)	128 (89-155)
Change prox	45 (36)	36 (12-80)
% change prox	-0.01 (.47)	-0.03 (-0.253-0.312)
Change mid	55 (50)	45.5 (16.9-74.2)
% change mid	0.11 (0.66)	1 (-20-33)
Change distal	69 (76)	48.7 (20-92)
% change distal	0.1 (0.89)	-12% (-45-38)
PSG pre TIPS revision mmHg	14 (12)	12 (9-15)
PSG after TIPS revision mmHg	8.32 (3.7)	8 (6-10)
Outcome (Alive/LT/Dead) %	49/13/37
TIPS stenosis (Y) %	43%
TIPS revised	44%

SD: Standard deviation; IQR: Interquartile range; HCV: Hepatitis C virus; NASH: Non-alcoholic steatohepatitis; TIPS: Transjugular intrahepatic portosystemic shunt; VB: Variceal bleeding; MELD: Model for End-Stage Liver Disease; PSG: Porto-systemic gradient.

Table 2 Comparison of those who underwent transjugular intrahepatic portosystemic shunt revision

Characteristic	*Yes revision (n =* 39)**	*No revision (n =* 50)**	P value
Age	56.7 (12)	57.3 (7.6)
% male/female	51/49	74/26	0.0266
% White/Black/other	72/23/5	80/18/2
Etiology of liver disease %			0.08
EtOH	26	36
HCV	11	20
NASH	21	20
Indication for TIPS %			0.05
VB	53	50
Refractory ascites	34	46
MELD at initial TIPS	15.8 (6.5)	17.2 (5.8)
PSG before TIPS mmHg	15.9 (5.1)	15.1 (4.0)
PSG after TIPS mmHg	5.89 (3.1)	6.3 (2.1)
TIPS dilation mm	8.6 (1.04)	8.2 (0.76)
Days to TIPS revision	572 (740)	466 (612)
Indication for revision (% doppler)	84	59	0.006
MELD at revision	15.5 (6.8)	18.7 (6.5)	0.03
Revision indication	84 [flow issue]	66 [clinical]	.04
Doppler abnormal %	78 [> 5% change proximal flow]	86 [< 5% change]	0.39
High vel/low vel/clinical %	23/51/23	46/16/36	0.0028
DF at revision Doppler prox cm/s	103 (64)	134 (21)	0.0356
DF at revision Doppler mid	109 (92)	151 (52)	0.017
DF at revision Doppler distal	86.6 (72)	174 (105)	0.0003
TIPS occluded %	23	2	0.0019
DF pre-TIPS baseline prox cm/s	112 (50)	133 (36)	0.044
DF pre-TIPs baseline mid	125 (52)	140 (32)	0.16
DF pre-TIPS baseline distal	117 (58)	136 (45)	0.13
Change prox	42 (37)	47 (36)
% change prox	-0.11 (0.42)	0.10 (0.49)
Change mid	69 (69)	46 (30)	0.1
% change mid	-0.057 (0.69)	0.16 (0.51)	0.17/.05 (Wilcoxon)
Change distal	62.9 (51)	73 (89)
% change distal	-0.20 (0.76)	0.32 (0.92)	0.021/0.0014 (Wilcoxan)
PSG pre TIPS revision mmHg	15.5 (6.1)	13.1(14.8)
PSG after TIPS revision mmHg	8.11 (4.3)	8.46 (3.3)
Outcome (Alive/LT/Dead) %	61/13/26	40/14/46	0.1
TIPS stenosis (Y) %	100	46	< 0.0001

DF: Doppler flow; HCV: Hepatitis C virus; NASH: Non-alcoholic steatohepatitis; TIPS: Transjugular intrahepatic portosystemic shunt; VB: Variceal bleeding; MELD: Model for End-Stage Liver Disease; PSG: Porto-systemic gradient.

Table 3 Area under the curve based on intra-transjugular intrahepatic portosystemic shunt velocity

TIPS velocity	Area under the curve
Proximal flow velocity	0.65
Mid flow velocity	0.71
Distal flow velocity	0.79 (P = 0.0007)

TIPS: Transjugular intrahepatic portosystemic shunt.

Table 4 Performance of doppler ultrasound in predicting need for transjugular intrahepatic portosystemic shunt revision

Performance characteristic
Sensitivity	40%
Specificity	45%
Negative predictive value	14%
Positive predictive value	78%

Citation: Duong N, Healey M, Patel K, Strife BJ, Sterling RK. Use of doppler ultrasound to predict need for transjugular intrahepatic portosystemic shunt revision. World J Hepatol 2022; 14(6): 1200-1209
URL: https://www.wjgnet.com/1948-5182/full/v14/i6/1200.htm
DOI: https://dx.doi.org/10.4254/wjh.v14.i6.1200