Carr Caitlin E, Tuite Catherine M, Soulen Michael C, Shlansky-Goldberg Richard D, Clark Timothy W I, Mondschein Jeffrey I, Kwak Andrew, Patel Aalpen A, Coleman Beverly G, Trerotola Scott O
Department of Radiology, Division of Interventional Radiology, University of Pennsylvania Medical Center, 1 Silverstein, 3400 Spruce Street, Philadelphia, 19104, USA.
J Vasc Interv Radiol. 2006 Aug;17(8):1297-305. doi: 10.1097/01.RVI.0000231951.47931.82.
To assess ultrasound (US) surveillance of expanded polytetrafluoroethylene (ePTFE)-covered stents in transjugular intrahepatic portosystemic shunts (TIPS).
Procedural data, including stent size and portosystemic gradients (PSG) before and after creation of TIPS, were obtained retrospectively in 55 patients (33 men, 22 women). Chart review provided clinical information, including etiology of liver disease, indication for TIPS creation, and Child-Pugh class. Radiology reports provided US venography data and pathology reports confirmed shunt status in transplant recipients. Patients had baseline US examinations 3-7 days after TIPS creation with scheduled follow-up at 1, 3, 6, and 12 months after the procedure. Clinical and radiology reports were compared to evaluate US surveillance of Viatorr stents.
One hundred fifty-nine US examinations were performed on 52 patients, for an average 3.1 studies per patient (range, 1-7) over a mean follow-up duration of 173 days (range, 0-1,013 d). Sixty-four US studies (40%) were baseline studies, 88 studies (55%) were routine follow-up studies, and seven (4%) were interval studies. US predicted TIPS abnormalities in 30 of 159 studies (19%); venography followed 15 of 30 abnormal US findings (50%) and clinical examinations complemented 10 of 15 venograms (67%). Venography and US were concordant in eight of 15 paired studies (53%); clinical examinations, when conducted, accurately predicted shunt status in all but one case. US findings changed management in six of 159 studies (4%): five of six (83%) were baseline evaluations and the other one (17%) was a routine follow-up examination. A total of five baseline US examinations (8%) and one surveillance examination (1%) altered patient management.
A single US examination after a TIPS procedure to confirm immediate function may be valuable, but routine US is not effective for long-term surveillance of ePTFE-covered stents.
评估超声（US）对经颈静脉肝内门体分流术（TIPS）中膨体聚四氟乙烯（ePTFE）覆膜支架的监测情况。
回顾性收集55例患者（33例男性，22例女性）的手术数据，包括TIPS建立前后的支架尺寸和门体压力梯度（PSG）。通过查阅病历获取临床信息，包括肝病病因、TIPS建立的指征以及Child-Pugh分级。放射学报告提供超声静脉造影数据，病理报告证实移植受者的分流状态。患者在TIPS建立后3 - 7天进行基线超声检查，并在术后1、3、6和12个月进行定期随访。比较临床和放射学报告以评估Viatorr支架的超声监测情况。
对52例患者进行了159次超声检查评估，平均每位患者进行3.1次检查（范围为1 - 7次），平均随访时间为173天（范围为0 - 1013天）。64次超声检查（40%）为基线检查，88次检查（55%）为常规随访检查，7次（4%）为间隔检查。在159次检查中，超声预测TIPS异常30次（19%）；静脉造影追踪了30次超声异常结果中的15次（50%），临床检查补充了15次静脉造影中的10次（67%）。在15对配对研究中，静脉造影和超声结果有8对一致（53%）；临床检查在除一例之外的所有病例中均准确预测了分流状态。超声检查结果改变了159次检查中的6次（4%）管理决策：6次中的5次（83%）为基线评估检查，另1次（17%）为常规随访检查。共有5次基线超声检查（8%）和1次监测检查（1%）改变了患者的管理决策。
TIPS术后进行一次超声检查以确认即刻功能可能有价值，但常规超声对ePTFE覆膜支架的长期监测效果不佳。
