Hepatic perfusion before and after the transjugular intrahepatic portosystemic shunt procedure: Impact on survival

Eric M. Walser, Rosinda DeLa Pena, Javier Villanueva-Meyer, Orhan Ozkan, Roger Soloway

Research output: Contribution to journalArticle

29 Scopus citations

Abstract

Purpose: This study correlates transjugular intrahepatic portosystemic shunt (TIPS) mortality with flow patterns in the cirrhotic liver. Materials and methods: Twenty-seven TIPS patients and 10 control subjects were used for this study. The authors evaluated hepatic perfusion with venous injections of Tc-99m pertechnetate before and after TIPS. Hepatic time-activity curves were analyzed for type and amount of liver perfusion. These parameters were correlated with survival for a mean follow-up of 18 months. Results: The mean arterial contribution to liver blood flow was 25.4% in the normal control patients, 39.9% in patients prior to TIPS, and increased to 48.3% after TIPS. Although the proportion of arterial supply to the cirrhotic liver varied widely, TIPS mortality did not correlate with the preprocedure hepatic artery/portal venous perfusion ratio. However, patients with both an 'arterialized' flow pattern and low total hepatic perfusion had higher mortality, with a mean survival of 2 months compared to patients with a more favorable perfusion profile (mean survival, 28.4 months). Conclusions: The proportion of arterial perfusion to the liver before TIPS did not affect survival. However, patients with a combination of reduced total hepatic perfusion and an arterial flow pattern had poorer survival, suggesting that both the quantity and quality of hepatic perfusion predicts TIPS outcome.

Original languageEnglish (US)
Pages (from-to)913-918
Number of pages6
JournalJournal of Vascular and Interventional Radiology
Volume11
Issue number7
DOIs
StatePublished - Jan 1 2000

    Fingerprint

Keywords

  • Liver, blood supply
  • Liver, cirrhosis
  • Shunts, portosystemic

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this