Abstract: Before transjugular intrahepatic portosystemic shunts (TIPS), sonography is used to identify patients with unsuitable hepatic and portal venous anatomy and to plan the procedure for those with suitable anatomy. Specifically, sonography is used to assess the size and morphology of the liver parenchyma, to detect hepatic masses, cysts, or biliary ductal dilatation, and to evaluate the hepatic vasculature for patency and direction of flow. A survey of the abdomen also will show the amount of ascites and the location of the liver relative to external landmarks. During TIPS, sonography may be used to facilitate atraumatic entry into the internal jugular vein or to guide puncture of the portal vein. After TIPS, routine sonography is used to detect shunt dysfunction. We routinely image patients at 24 hours, 3 months, 6 months, and every 6 months thereafter. Three findings most suggestive of shunt malfunction that prompt further investigation by shunt venography are (1) absent Doppler flow within the shunt, (2) peak flow velocity in the midshunt of 50 cm/sec or less, (3) reversal of flow direction in the intrahepatic portal vein branches from hepatofugal to hepatopetal. Before transjugular intrahepatic portosystemic shunts (TIPS), sonography is used to identify patients with unsuitable hepatic and portal venous anatomy and to plan the procedure for those with suitable anatomy. Specifically, sonography is used to assess the size and morphology of the liver parenchyma, to detect hepatic masses, cysts, or biliary ductal dilatation, and to evaluate the hepatic vasculature for patency and direction of flow. A survey of the abdomen also will show the amount of ascites and the location of the liver relative to external landmarks. During TIPS, sonography may be used to facilitate atraumatic entry into the internal jugular vein or to guide puncture of the portal vein. After TIPS, routine sonography is used to detect shunt dysfunction. We routinely image patients at 24 hours, 3 months, 6 months, and every 6 months thereafter. Three findings most suggestive of shunt malfunction that prompt further investigation by shunt venography are (1) absent Doppler flow within the shunt, (2) peak flow velocity in the midshunt of 50 cm/sec or less, (3) reversal of flow direction in the intrahepatic portal vein branches from hepatofugal to hepatopetal.
Publication Year: 1998
Publication Date: 1998-06-01
Language: en
Type: article
Indexed In: ['crossref']
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Cited By Count: 4
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