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