Follow-up of TIPS: Assessment of signs of dysfunction at Doppler sonography

Purpose : to assess the signs of TIPS dysfunction at Doppler sonography. Materials and methods : retrospective study of signs observed in 106 TIPS including 31 TIPS with dysfunction (portoauricular pressure gradient >12 mmHg). Results : the signs of TIPS dysfunction were a decrease in the mean velocity in the TIPS (for a velocity <40 cm/sec, 90% sensitivity, 96% specificity), a hepatopetal intrahepatic portal flow (on the right 90% sensitivity, 100% specificity, on the left 95% sensitivity, 92% specificity), a lack of cardiac modulation of the signal in the TIPS (93% sensitivity, 65% specificity), a hepatic vein flow reversal (30% sensitivity, 100% specificity), and, the only direct sign of stenosis, an increase of the mean velocity in the stenosis (42% sensitivity, 95% specificity for a velocity > or = 1 m/sec). Conclusion : the most sensitive Doppler signs of tips dysfunction are the indirect signs of stenosis.