Abstract
The purpose of this study was to investigate alterations of hepatic arterial flow during transjugular intrahepatic portosystemic stent shunt (TIPS) applying intravascular Doppler sonography. This prospective monocenter study included 25 patients with liver cirrhosis (alcohol induced [n = 19], chronic hepatitis associated [n = 3], primary biliary cirrhosis associated [n = 1], and cryptogenic [n = 2]) successfully treated with TIPS. All patients underwent intravascular hepatic arterial flow measurements during TIPS using an endoluminal flow sensor. The average arterial peak velocity (APV) and the maximum arterial peak velocity (MPV) were registered. Twenty-two patients (88%) showed increased APV, one patient (4%) showed unaffected APV, and two patients (8%) showed decreased APV after TIPS. The average portosystemic pressure gradient decreased significantly, from 22.0 ± 5.1 mmHg before TIPS to 11.0 ± 4.1 mmHg after TIPS (−50.0%; p < 0.0001). The average APV increased significantly, from 41.9 ± 17.8 cm/s before TIPS to 60.7 ± 19.0 cm/s after TIPS (+44.9%; p < 0.0001). The average MPV increased significantly, from 90.8 ± 31.7 cm/s before TIPS to 112.6 ± 34.9 cm/s after TIPS (+24.0%; p = 0.0002). These changes in perfusion set in within seconds after TIPS tract formation in all the patients with increased APV. We conclude that TIPS-induced portosystemic decompression leads to a significant increase in hepatic arterial flow. The changes occurred within seconds, suggesting a reflex-like mechanism.
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Abbreviations
- APV:
-
Average arterial peak velocity
- MPV:
-
Maximum arterial peak velocity
- s:
-
Seconds
- TIPS:
-
Transjugular intrahepatic portosystemic stent shunt
References
Zipprich A, Steudel N, Meiss F et al (2001) Oxygen supplementation improves methacetin clearance in patients with cirrhosis-relation to liver function. Gastroenterology 120(Suppl 1):39
Richter S, Mücke I, Menger MD et al (2000) Impact of intrinsic blood flow regulation in cirrhosis: maintenance of hepatic arterial buffer response. Am J Physiol Gastrointest Liver Physiol 279:G454–G462
Gülberg V, Haag K, Rossle M et al (2002) Hepatic arterial buffer response in patients with advanced cirrhosis. Hepatology 35:630–634
Keussen I, Song HY, Bajc M et al (2002) Changes in the distribution of hepatic arterial blood flow following TIPS with uncovered stent and stent-graft: an experimental study. CardioVasc Interv Radiol 25:314–317
Walser E, Ozkan OS, Raza S et al (2003) Hepatic perfusion as a predictor of mortality after transjugular intrahepatic portosystemic shunt creation in patients with refractory ascites. J Vasc Interv Radiol 14:1251–1257
Weidekamm C, Cejna M, Kramer L et al (2005) Effects of TIPS on liver perfusion measured by dynamic CT. AJR 184:505–510
World Medical Association Declaration of Helsinki (1997) Recommendations guiding physicians in biomedical research involving human subjects. Cardiovasc Res 35:2–3
Richter GM, Noeldge G, Palmaz JC et al (1990) Transjugular intrahepatic portacaval stent shunt: preliminary clinical results. Radiology 174:1027–1030
Richter GM, Noeldge G, Palmaz JC et al (1990) The transjugular intrahepatic portosystemic stent-shunt (TIPSS): results of a pilot study. CardioVasc Interv Radiol 13:200–207
Richter GM, Palmaz JC, Noldge G et al (1989) The transjugular intrahepatic portosystemic stent-shunt. A new nonsurgical percutaneous method. Radiologe 29:406–411
Itkin M, Trerotola SO, Kolff JW et al (2004) Measurement of portal blood and transjugular intrahepatic portosystemic shunt flow with use of a retrograde thermodilutional catheter. J Vasc Interv Radiol 15:1105–1110
Itkin M, Trerotola SO, Stavropoulos SW et al (2006) Portal flow and arterioportal shunting after transjugular intrahepatic portosystemic shunt creation. J Vasc Interv Radiol 17:55–62
Doucette JW, Corl PD, Payne HM et al (1992) Validation of a Doppler guide wire for intravascular measurement of coronary artery flow velocity. Circulation 85:1899–1911
Ofili E, Kern MJ, Tatineni S et al (1991) Detection of coronary collateral flow by a Doppler-tipped guide wire during coronary angioplasty. Am Heart J 122:221–225
Segal J, Kern MJ, Scott NA et al (1992) Alterations of phasic coronary artery flow velocity in humans during percutaneous coronary angioplasty. J Am Coll Cardiol 20:276–286
Segal J, Nassi M, Ford AJ Jr et al (1990) Instantaneous and continuous cardiac output in humans obtained with a Doppler pulmonary artery catheter. J Am Coll Cardiol 16:1398–1407
Richter GM, Brado M, Simon C et al (1997) Changes in liver perfusion caused by transjugular intrahepatic stent shunt (TIPSS). Zentralbl Chir 122:108–116
Henderson JM, Gilmore GT, Mackay GJ et al (1992) Hemodynamics during liver transplantation: the interactions between cardiac output and portal venous and hepatic arterial flows. Hepatology 16:715–718
Jakab F, Sugar I, Rath Z et al (1996) The relationship between portal venous and hepatic arterial blood flow. I. Experimental liver transplantation. HPB Surg 10:21–26
Payen DM, Fratacci MD, Dupuy P et al (1990) Portal and hepatic arterial blood flow measurements of human transplanted liver by implanted Doppler probes: interest for early complications and nutrition. Surgery 107:417–427
Lautt WW (1985) Mechanism and role of intrinsic regulation of hepatic arterial blood flow: hepatic arterial buffer response. Am J Physiol 249:G549–G556
Houssin D, Fratacci M, Dupuy P et al (1989) One week of monitoring of portal and hepatic arterial blood flow after liver transplantation using implantable pulsed Doppler microprobes. Transplant Proc 21:2277–2278
Marcos A, Olzinski AT, Ham JM et al (2000) The interrelationship between portal and arterial blood flow after adult to adult living donor liver transplantation. Transplantation 70:1697–1703
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Radeleff, B., Sommer, CM., Heye, T. et al. Acute Increase in Hepatic Arterial Flow During TIPS Identified by Intravascular Flow Measurements. Cardiovasc Intervent Radiol 32, 32–37 (2009). https://doi.org/10.1007/s00270-008-9435-0
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DOI: https://doi.org/10.1007/s00270-008-9435-0