Goal:
To discuss the role of strict criteria for Doppler-ultrasonography (US) combined with clinical features in the diagnosis of transjugular intrahepatic portosystemic shunt (TIPS) dysfunction in the new era of covered stents. In light of lacking research regarding the accuracy of Doppler-ultrasonography in TIPS dysfunction evaluation using covered stents, and a recenty published meta-analysis which reviewed primarily bare metal stents ,but never the less concluded that ultrasound for TIPS dusfunction in the setting of covered metal stent appeared to have acceptable sensitivuty of 0.82 but limited specificity of 0.58 ,we aim to provide our single center case series for further investigation.
Methods:
Eleven angiography exams, in 5 patients, for TIPS revision were perfomed in our institution since 2010. All patients underwent insertion of covered stents . All of these exams were preceded by a positive clinical evaluation for portal hypertension and a possitive Doppler US ,addhering to strict criteria , for TIPS disfunction .
Results:
All of the Doppler-US and the angiography results matched in their results, of which 10 out of 11 were positive for TIPS dysfunction.
Conclusion:
The performance of Doppler-US for the detection of TIPS dysfunction correlated well with angiography results in our single center study. Using a combination of clinical signs and Doppler-US diagnostic test , addhering to strict criteria ,may raise its accuracy. Considering our results, there’s a prominent need to revaluate strict critria for Doppler-US as a non-invasive, cheap and available tool for the diagnosis of TIPS dysfunction in the covered stents era.
