Implantability, Complications, and Follow-Up After Transjugular Intrahepatic Portosystemic Stent-Shunt Creation With the 6F Self-Expanding Sinus-SuperFlex-Visual Stent

Diagnostic Value of Contrast-Enhanced Ultrasound for Evaluation of Transjugular Intrahepatic Portosystemic Shunt Perfusion

BACKGROUND

In patients with liver cirrhosis, transjugular intrahepatic portosystemic shunt (TIPS) displays an effective method for treating portal hypertension. Main indications include refractory ascites and secondary prevention of esophageal bleeding. Color Doppler ultrasound (CDUS) plays a leading role in the follow-up management, whereas contrast-enhanced ultrasound (CEUS) is not routinely considered. We compared the efficacy of CEUS to CDUS and highlighted differences compared to findings of corresponding computed tomography (CT) and magnetic resonance imaging (MRI). (2) Methods: On a retrospective basis, 106 patients with CEUS examination after TIPS were included. The enrollment period was 12 years (between 2008 and 2020) and the age group ranged from 23.3 to 82.1 years. In addition, 92 CDUS, 43 CT and 58 MRI scans were evaluated for intermodal comparison. (3) Results: Intermodal analysis and comparison revealed a high level of concordance between CDUS, CT and MRI in the vast majority of cases. In comparison to CDUS, the correlation of the relevant findings was 92.5%, 95.3% for CT and 87.9% for MRI. In some cases, however, additional information was provided by CEUS (4) Conclusions: CEUS depicts a safe and effective imaging modality for follow-up after TIPS. In addition to CDUS, CEUS enables specific assessment of stent pathologies and stent dysfunction due to its capacity to dynamically visualize single microbubbles at high spatial and temporal resolution. Due to the low number of adverse events regarding the application of contrast agents, CEUS can be administered to a very broad patient population, thus avoiding additional radiation exposure compared to CT angiography in cases with divergent findings during follow-up.

Value of virtual touch tissue quantification in evaluating therapeutic effects of transjugular intrahepatic portosystemic stent shunt

BACKGROUND

Virtual touch tissue quantification (VTQ) is a new ultrasonic technology which can quantitatively analyze the elastic hardness of tissue. It is convenient, noninvasive, and repeatable. In the present study, the changes of tissue hardness of the liver and spleen after transjugular intrahepatic portosystemic stent shunt (TIPSS) were analyzed quantitatively to assess the clinical therapeutic effects, with an aim to provide a valuable imaging method for the evaluation of therapeutic effects of TIPSS.

AIM

To explore the clinical value of VTQ in evaluating the therapeutic effects of TIPSS.

METHODS

Fifty-two cirrhotic patients with portal hypertension were selected as subjects. The shear wave velocity (SWV) of the liver and spleen was measured by VTQ one day before operation and one month after operation, and the changes of SWV of the liver and spleen were compared.

RESULTS

The velocities of the portal vein and splenic vein after TIPSS increased significantly compared with those before TIPSS (P < 0.05). The diameter of the portal vein after TIPSS decreased significantly compared with that before TIPSS (P < 0.05). The SWV of the liver and spleen after TIPSS decreased significantly compared with those before TIPSS (P < 0.05).

CONCLUSION

VTQ is a noninvasive method to measure the SWV of the liver and spleen, which can effectively monitor the therapeutic effect of TIPSS.

Unsolved Questions in Salvage TIPSS: Practical Modalities for Placement, Alternative Therapeutics, and Long-Term Outcomes

Salvage transjugular intrahepatic portosystemic shunt (TIPSS) has proven its efficacy to treat refractory variceal bleeding for patients with cirrhosis. However, this procedure is associated with very poor outcomes. As it is used as a last resort to treat a severe complication of cirrhosis, it seems essential to improve our practice, with the aim of optimizing management of those patients. Somehow, many questions are still unsolved: which stents should be used? Should a concomitant embolization be systematically considered? Is there any alternative therapeutic in case of recurrent bleeding despite TIPSS? What are the long-term outcomes on survival, liver transplantation, and hepatic encephalopathy after salvage TIPSS? Is this procedure futile in some patients? Is prognosis with salvage TIPSS nowadays as bad as earlier, despite the improvement of prophylaxis for variceal bleeding? The aim of this review is to summarize those data and to identify the lacking ones to guide further research on salvage TIPSS.