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

N. H. Patel, K. J. Sasadeusz, R. Seshadri, Naga Chalasani, H. Shah, M. S. Johnson, J. Namyslowski, K. P. Moresco, S. O. Trerotola

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

PURPOSE: To determine (i) whether there is a significant increase in hepatic artery blood flow (HABF) after transjugular intrahepatic portosystemic shunt (TIPS) creation and (ii) whether the extent of incremental increase in HABF is predictive of clinical outcome after TIPS creation. MATERIALS AND METHODS: Prospective, nonrandomized, nonblinded duplex Doppler ultrasound (US) examinations were performed on 24 consecutive patients (19 men; Child Class A/B/C: 4/12/8, respectively) with a mean age of 52.8 years who were referred for TIPS creation for variceal bleeding. Peak hepatic artery velocity and vessel dimensions were used to calculate the hepatic arterial blood flow (HABF) before and after TIPS creation. Patients were clinically followed in the gastrohepatology clinic and TIPS US surveillance was performed at 1 and 3 months to assess shunt function. The extent of incremental increase in HABF was analyzed as a predictor of post-TIPS encephalopathy and/or death. RESULTS: The technical success rate of TIPS creation was 100%. The shunt diameters were either 10 mm (n = 11) or 12 mm (n = 13). TIPS resulted in a significant reduction in the portosystemic gradient from 24.3 mm Hg ± 5.7 to 9.3 mm Hg ± 2.9 (P < .001). The hepatic artery peak systolic velocity and HABF increased significantly after TIPS creation, from 60.8 cm/sec ± 26.7 to 121 cm/sec ± 51.5 (P < .001) and from 254.2 mL/min ± 142.2 to 507.8 mL/min ± 261.3 (P < .001), respectively. The average incremental increase 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 the two. All shunts were patent at 30 and 90 days without sonographic evidence of shunt dysfunction. After TIPS creation, new or worsened encephalopathy developed in five patients at 30 days and in an additional three at 90 days. They were all successfully managed medically. Three patients (12.5%) died 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.

Original languageEnglish
Pages (from-to)1279-1284
Number of pages6
JournalJournal of Vascular and Interventional Radiology
Volume12
Issue number11
StatePublished - 2001

Fingerprint

Transjugular Intrahepatic Portasystemic Shunt
Brain Diseases
Hepatic Artery
Mortality
Liver
Doppler Ultrasonography
Hepatic Encephalopathy

Keywords

  • Liver, blood supply
  • Shunts, portosystemic

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Increase in hepatic arterial blood flow after transjugular intrahepatic portosystemic shunt creation and its potential predictive value of postprocedural encephalopathy and mortality. / Patel, N. H.; Sasadeusz, K. J.; Seshadri, R.; Chalasani, Naga; Shah, H.; Johnson, M. S.; Namyslowski, J.; Moresco, K. P.; Trerotola, S. O.

In: Journal of Vascular and Interventional Radiology, Vol. 12, No. 11, 2001, p. 1279-1284.

Research output: Contribution to journalArticle

Patel, N. H. ; Sasadeusz, K. J. ; Seshadri, R. ; Chalasani, Naga ; Shah, H. ; Johnson, M. S. ; Namyslowski, J. ; Moresco, K. P. ; Trerotola, S. O. / Increase in hepatic arterial blood flow after transjugular intrahepatic portosystemic shunt creation and its potential predictive value of postprocedural encephalopathy and mortality. In: Journal of Vascular and Interventional Radiology. 2001 ; Vol. 12, No. 11. pp. 1279-1284.
@article{f2cfe935f49844069e0e27f85f2d8aab,
title = "Increase in hepatic arterial blood flow after transjugular intrahepatic portosystemic shunt creation and its potential predictive value of postprocedural encephalopathy and mortality",
abstract = "PURPOSE: To determine (i) whether there is a significant increase in hepatic artery blood flow (HABF) after transjugular intrahepatic portosystemic shunt (TIPS) creation and (ii) whether the extent of incremental increase in HABF is predictive of clinical outcome after TIPS creation. MATERIALS AND METHODS: Prospective, nonrandomized, nonblinded duplex Doppler ultrasound (US) examinations were performed on 24 consecutive patients (19 men; Child Class A/B/C: 4/12/8, respectively) with a mean age of 52.8 years who were referred for TIPS creation for variceal bleeding. Peak hepatic artery velocity and vessel dimensions were used to calculate the hepatic arterial blood flow (HABF) before and after TIPS creation. Patients were clinically followed in the gastrohepatology clinic and TIPS US surveillance was performed at 1 and 3 months to assess shunt function. The extent of incremental increase in HABF was analyzed as a predictor of post-TIPS encephalopathy and/or death. RESULTS: The technical success rate of TIPS creation was 100{\%}. The shunt diameters were either 10 mm (n = 11) or 12 mm (n = 13). TIPS resulted in a significant reduction in the portosystemic gradient from 24.3 mm Hg ± 5.7 to 9.3 mm Hg ± 2.9 (P < .001). The hepatic artery peak systolic velocity and HABF increased significantly after TIPS creation, from 60.8 cm/sec ± 26.7 to 121 cm/sec ± 51.5 (P < .001) and from 254.2 mL/min ± 142.2 to 507.8 mL/min ± 261.3 (P < .001), respectively. The average incremental increase 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 the two. All shunts were patent at 30 and 90 days without sonographic evidence of shunt dysfunction. After TIPS creation, new or worsened encephalopathy developed in five patients at 30 days and in an additional three at 90 days. They were all successfully managed medically. Three patients (12.5{\%}) died 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.",
keywords = "Liver, blood supply, Shunts, portosystemic",
author = "Patel, {N. H.} and Sasadeusz, {K. J.} and R. Seshadri and Naga Chalasani and H. Shah and Johnson, {M. S.} and J. Namyslowski and Moresco, {K. P.} and Trerotola, {S. O.}",
year = "2001",
language = "English",
volume = "12",
pages = "1279--1284",
journal = "Journal of Vascular and Interventional Radiology",
issn = "1051-0443",
publisher = "Elsevier Inc.",
number = "11",

}

TY - JOUR

T1 - Increase in hepatic arterial blood flow after transjugular intrahepatic portosystemic shunt creation and its potential predictive value of postprocedural encephalopathy and mortality

AU - Patel, N. H.

AU - Sasadeusz, K. J.

AU - Seshadri, R.

AU - Chalasani, Naga

AU - Shah, H.

AU - Johnson, M. S.

AU - Namyslowski, J.

AU - Moresco, K. P.

AU - Trerotola, S. O.

PY - 2001

Y1 - 2001

N2 - PURPOSE: To determine (i) whether there is a significant increase in hepatic artery blood flow (HABF) after transjugular intrahepatic portosystemic shunt (TIPS) creation and (ii) whether the extent of incremental increase in HABF is predictive of clinical outcome after TIPS creation. MATERIALS AND METHODS: Prospective, nonrandomized, nonblinded duplex Doppler ultrasound (US) examinations were performed on 24 consecutive patients (19 men; Child Class A/B/C: 4/12/8, respectively) with a mean age of 52.8 years who were referred for TIPS creation for variceal bleeding. Peak hepatic artery velocity and vessel dimensions were used to calculate the hepatic arterial blood flow (HABF) before and after TIPS creation. Patients were clinically followed in the gastrohepatology clinic and TIPS US surveillance was performed at 1 and 3 months to assess shunt function. The extent of incremental increase in HABF was analyzed as a predictor of post-TIPS encephalopathy and/or death. RESULTS: The technical success rate of TIPS creation was 100%. The shunt diameters were either 10 mm (n = 11) or 12 mm (n = 13). TIPS resulted in a significant reduction in the portosystemic gradient from 24.3 mm Hg ± 5.7 to 9.3 mm Hg ± 2.9 (P < .001). The hepatic artery peak systolic velocity and HABF increased significantly after TIPS creation, from 60.8 cm/sec ± 26.7 to 121 cm/sec ± 51.5 (P < .001) and from 254.2 mL/min ± 142.2 to 507.8 mL/min ± 261.3 (P < .001), respectively. The average incremental increase 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 the two. All shunts were patent at 30 and 90 days without sonographic evidence of shunt dysfunction. After TIPS creation, new or worsened encephalopathy developed in five patients at 30 days and in an additional three at 90 days. They were all successfully managed medically. Three patients (12.5%) died 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.

AB - PURPOSE: To determine (i) whether there is a significant increase in hepatic artery blood flow (HABF) after transjugular intrahepatic portosystemic shunt (TIPS) creation and (ii) whether the extent of incremental increase in HABF is predictive of clinical outcome after TIPS creation. MATERIALS AND METHODS: Prospective, nonrandomized, nonblinded duplex Doppler ultrasound (US) examinations were performed on 24 consecutive patients (19 men; Child Class A/B/C: 4/12/8, respectively) with a mean age of 52.8 years who were referred for TIPS creation for variceal bleeding. Peak hepatic artery velocity and vessel dimensions were used to calculate the hepatic arterial blood flow (HABF) before and after TIPS creation. Patients were clinically followed in the gastrohepatology clinic and TIPS US surveillance was performed at 1 and 3 months to assess shunt function. The extent of incremental increase in HABF was analyzed as a predictor of post-TIPS encephalopathy and/or death. RESULTS: The technical success rate of TIPS creation was 100%. The shunt diameters were either 10 mm (n = 11) or 12 mm (n = 13). TIPS resulted in a significant reduction in the portosystemic gradient from 24.3 mm Hg ± 5.7 to 9.3 mm Hg ± 2.9 (P < .001). The hepatic artery peak systolic velocity and HABF increased significantly after TIPS creation, from 60.8 cm/sec ± 26.7 to 121 cm/sec ± 51.5 (P < .001) and from 254.2 mL/min ± 142.2 to 507.8 mL/min ± 261.3 (P < .001), respectively. The average incremental increase 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 the two. All shunts were patent at 30 and 90 days without sonographic evidence of shunt dysfunction. After TIPS creation, new or worsened encephalopathy developed in five patients at 30 days and in an additional three at 90 days. They were all successfully managed medically. Three patients (12.5%) died 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.

KW - Liver, blood supply

KW - Shunts, portosystemic

UR - http://www.scopus.com/inward/record.url?scp=0035171879&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0035171879&partnerID=8YFLogxK

M3 - Article

C2 - 11698626

AN - SCOPUS:0035171879

VL - 12

SP - 1279

EP - 1284

JO - Journal of Vascular and Interventional Radiology

JF - Journal of Vascular and Interventional Radiology

SN - 1051-0443

IS - 11

ER -