Daniel BL, Rubin JM, Fowlkes JB, Williams DM, Adler RS. The hemodynamics of transjugular intrahepatic portosystemic shunts: investigations with Doppler sonography and development of an in vitro model.
Acad Radiol 1996;
3:455-62. [PMID:
8796701 DOI:
10.1016/s1076-6332(96)80001-8]
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Abstract
RATIONALE AND OBJECTIVES
We evaluated Doppler sonography-based measurements of transjugular intrahepatic portosystemic shunt (TIPS) function and developed an in vitro model of normal TIPS hemodynamics.
METHODS
We reviewed retrospectively the results of all trans-TIPS manometries (N = 116) performed during a 24-month period. Portosystemic pressure gradient was compared with peak stent velocity as measured by angle-corrected Doppler sonography. A flow phantom simulating TIPS was created using 8-, 10-, and 12-mm-diameter wire-mesh stents placed in cylindrical channels with lengths ranging from 3.4 to 6.0 cm.
RESULTS
Among 50 trans-TIPS manometries with corresponding Doppler sonography performed on well-functioning shunts, measured portosystemic pressure gradient and peak velocity were not correlated (R2 = .014). On the basis of a regression of measurements in the flow phantom, pressure loss in a stented cylindrical channel was estimated as follows: delta p = rho.(0.145 -0.001.Rey + 0.816.L/D).(Vmean2/2), where rho is the fluid density, Rey is the Reynolds number, L is the channel length, D is the stent diameter, and Vmean is the time-averaged velocity within the stent. Predicted and measured pressure gradients were correlated (R2 = .91).
CONCLUSION
Peak velocity in patients with a normally functioning TIPS does not predict the magnitude of the portosystemic pressure gradient.
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