Pan J-J, Chen C, Geller B, Firpi R, Machicao V I, Caridi J G, Nelson D R, Morelli G
Department of Medicine, Division of Gastroenterology, Section of Hepatobiliary Disease, University of Florida, Gainesville, FL 32610, USA.
Clin Radiol. 2008 Oct;63(10):1142-8. doi: 10.1016/j.crad.2008.04.016. Epub 2008 Jul 16.
To investigate whether sonographic (US) surveillance of polytetrafluoroethylene covered transjugular intrahepatic portosystemic shunts (TIPS) is necessary.
We identified 128 patients who underwent TIPS for complications of portal hypertension between January 2001 and December 2005 at a large tertiary centre. Procedural data were retrospectively analysed. US surveillance of the TIPS was performed at baseline with scheduled follow-up or whenever shunt dysfunction was suspected. Clinical and radiology reports were compared to assess US surveillance of the TIPS.
Four hundred and twenty-six US studies were performed, with a median of three per patient (range 1-5). The median follow-up period was 378 days (range 1-1749 days). Twenty-three patients (18%) had baseline US studies performed only whereas 105 (82%) also had follow-up studies. Forty-one (32%) of 128 patients [32 (78%) Wallstent, nine (22%) Viatorr] had Doppler ultrasound abnormalities noted. Venography was performed in all 41 patients. Abnormal venography and elevated hepatic venous pressure gradient (HVPG) was seen in 34 (82.9%) of the 41 patients [29 (85.3%) Wallstent, five (14.7%) Viatorr]. Among the 34 patients, 17 (50%) [13 (76.5%) Wallstent, four (23.5%) Viatorr] had venographic abnormalities noted at the hepatic venous end accompanied by increased HVPG. All four of the Viatorr patients had minor narrowing at the hepatic venous end and HVPG measurements that ranged 3-4 mm Hg above 12 mm Hg.
Considering the improved patency of covered stents in TIPS, US surveillance may be superfluous after the baseline study.
探讨对聚四氟乙烯覆膜经颈静脉肝内门体分流术（TIPS）进行超声（US）监测是否必要。
我们确定了2001年1月至2005年12月期间在一家大型三级中心因门静脉高压并发症接受TIPS治疗的128例患者。对手术数据进行回顾性分析。在基线时对TIPS进行超声监测，并安排定期随访，或在怀疑分流功能障碍时随时进行监测。比较临床和放射学报告以评估对TIPS的超声监测情况。
共进行了426次超声检查，每位患者的检查次数中位数为3次（范围1 - 5次）。随访期中位数为378天（范围1 - 1749天）。23例患者（18%）仅进行了基线超声检查，而105例（82%）还进行了随访检查。128例患者中有41例（32%）[32例（78%）使用Wallstent，9例（22%）使用Viatorr]的多普勒超声检查发现异常。所有41例患者均进行了静脉造影。41例患者中有34例（82.9%）[29例（85.3%）使用Wallstent，5例（14.7%）使用Viatorr]出现静脉造影异常和肝静脉压力梯度（HVPG）升高。在这34例患者中，17例（50%）[13例（76.5%）使用Wallstent，4例（23.5%）使用Viatorr]在肝静脉端出现静脉造影异常，同时HVPG升高。所有4例使用Viatorr支架的患者在肝静脉端均出现轻度狭窄，HVPG测量值比12 mmHg高3 - 4 mmHg。
考虑到覆膜支架在TIPS中的通畅性有所改善，基线检查后进行超声监测可能多余
