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Dopplerflowmetric patterns for evaluation of transjugular intrahepatic portosystemic shunt patency

Transjugular intrahepatic portosystemic shunt (TIPS) is a minimally invasive interventional procedure that consists of placement of an auto expandable metallic stent in the hepatic parenchyma via transjugular. It is used to treat the complications of portal hypertension, particularly digestive bleeding of gullet varices and refractory ascites. Although TIPS is an efficient procedure with low rate of failure some complications such as stenosis are frequent. Early diagnosis of stenosis is mandatory since it interferes with the type of treatment and the reappearing symptoms can be serious. Doppler sonography is used in the follow-up of this patients and many parameters indicating TIPS stenosis are described in the literature such as the minimum and maximum velocity flow inside the stent, the velocity flow in portal vein, the velocity gradient between different sites of the stent, among others. Unfortunately there is no consensus on which parameter or group of parameters is more efficient for diagnosis because the evaluation protocols varied among institutions. The authors reviewed the parameters of stenosis reported in literature and other important aspects for comprehension of this procedure including indications, contraindications and physiopathology of stenosis.

Portal hypertension; Transjugular intrahepatic portosystemic shunt; Doppler ultrasonography


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