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Use of Intravascular Ultrasound to Improve Diagnosis and Treatment of Transjugular Intrahepatic Portosystemic Shunt Dysfunction in Patients in the Long-term Follow-up. | LitMetric

AI Article Synopsis

  • This study aimed to assess how effective intravascular ultrasound (IVUS) is in treating transjugular intrahepatic portosystemic shunts (TIPS) that show signs of malfunction in patients.
  • Four patients underwent a revision procedure using IVUS along with phlebography and invasive pressure measurements, which facilitated targeted treatments like angioplasty and stent placement.
  • All patients experienced reduced symptoms, had no procedural complications, and showed clinical improvement, indicating that IVUS enabled better diagnosis and treatment of TIPS issues.

Article Abstract

Aim: To evaluate the efficacy of intravascular ultrasound (IVUS) in transjugular intrahepatic portosystemic shunt (TIPS) revision associated with phlebography and invasive pressure measurement in patients with clinical or radiological signs of TIPS malfunction.

Background: Four patients underwent TIPS revision between February and August 2021. Right internal jugular vein access was achieved under ultrasonographic guidance, a catheter was advanced to achieve the Inferior Vena Cava (IVC) and afterward the Portal vein through the TIPS. Once the Portal vein was achieved, a phlebography was performed, followed by invasive pressure measurement and IVUS exam over the guidewire. Based on the combination of phlebography, invasive pressure measurement, and IVUS evaluations, TIPS dysfunction was treated either with angioplasty or stent apposition.

Case Description: In all patients, we obtained the reduction of porto-systemic gradient. In three patients, angioplasty with a 10 mm diameter balloon catheter was performed. Anticoagulation therapy was added to one patient. In one patient, the Viatorr's proximal extremity in the suprahepatic vein wall was dislocated, so it was lengthened with a "Viabahn" covered stent. None of the patients developed hepatic encephalopathy after both TIPS placement and TIPS revision. No complications related to the procedure were observed during the follow-up. Clinical improvement in the immediate follow-up period was observed in all patients. In two patients, the abdominal ascites resolved. In another one, the abdominal pain disappeared, and a reduction of the longitudinal spleen diameter was recorded at 3 months follow-up.

Conclusion: The use of IVUS allowed us to correctly visualize the organic cause of TIPS malfunction and to obtain direct visualization of the results of endovascular treatment.

How To Cite This Article: Morosetti D, Lenci I, Argirò R, . Use of Intravascular Ultrasound to Improve Diagnosis and Treatment of Transjugular Intrahepatic Portosystemic Shunt Dysfunction in Patients in the Long-term Follow-up. Euroasian J Hepato-Gastroenterol 2022;12(1):50-56.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9357521PMC
http://dx.doi.org/10.5005/jp-journals-10018-1374DOI Listing

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