Duplex Ultrasound Versus Clinical Surveillance in the Prediction of TIPS Malfunction Placed for Refractory Ascites: Is Ultrasound Surveillance Useful?

Purpose: Since the advent of expanded polytetrafluoroethylene-covered stents and the improved patency they confer for transjugular intrahepatic portosystemic shunt (TIPS), the need to perform ultrasound surveillance has been debated. Prior reports have failed to separately evaluate patients who had TIPS placed for refractory ascites and variceal bleeding. The difference in morbidity from TIPS malfunction between these cohorts argues for distinction between the two. This retrospective review aims to determine whether Duplex ultrasound or return of symptoms more accurately predicts TIPS dysfunction.

Materials And Methods: Seventy-eight consecutive venograms in forty patients were retrospectively reviewed. TIPS venograms were used as the gold standard for TIPS dysfunction and considered abnormal if a pressure gradient >12 mmHg was discovered. Patients' charts were reviewed to assess for a return/worsening of ascites. Lastly, the two ultrasounds prior to TIPS revision were evaluated.

Results: The sensitivities of symptom relapse and ultrasound were 83 and 80.0%, respectively, while the specificities were 38.7 and 4.0%, respectively. The sensitivities were not found to be statistically different (p > 0.05); however, symptom relapse was found to be statistically more specific (p < 0.05).

Conclusion: Symptom relapse is as sensitive and perhaps more specific than ultrasound in patients who had TIPS placed for refractory ascites.