E2393. TIPS Ultrasound Discordance: A Pictorial Review
  1. Manuel Betancourt-Torres; The University of Alabama at Birmingham
  2. Brennan Barret; The University of Alabama at Birmingham
  3. Eric Bready; The University of Alabama at Birmingham
  4. Aliaksei Salei; The University of Alabama at Birmingham
  5. Rakesh Varma; The University of Alabama at Birmingham
With the advent of covered stent grafts, Transjugular Intrahepatic Portosystemic Shunt (TIPS) patency has improved significantly. Ultrasound Doppler still remains the modality of choice for shunt surveillance. However, there are multiple studies which have demonstrated limited utility of TIPS US Doppler as a screening modality. This exhibit is a pictorial review of various discordance between US Doppler and TIPS venography and the review of literature, attesting to the fact for the need of a better surveillance modality for TIPS.

Educational Goals / Teaching Points
Educational goals: - Review normal US doppler findings for tips surveillance. - Review post tips portogram findings and the significance of pressure gradients. - Illustrate various examples of TIPS US discordance aiming to supplement clinical and imaging findings to guide interventions. - Review of literature regarding the utility of tips us Doppler as a screening modality.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Imaging findings: - Illustrate the normal findings of tips venogram - Illustrate normal findings of tips us Doppler for surveillance - TIPS US discordance: a. Proximal end b. Mid stent c. Distal end d. Intrahepatic portal vein flow e. Main portal vein velocities

Conclusion: Understanding the limitations of Doppler ultrasound in asymptomatic patients will positively impact patient management and help avoid unnecessary interventions. Given these discordances, the need for a better surveillance modality should be explored.