Ultrasonography and doppler duplex compared with angiography in follow-up of mesocaval shunt patency

Abstract

Thirty-four patients with portal hypertension of various etiologies were operated upon with an interposition mesocaval Goretex graft. During a period of 6 years 84 angiographic and ultrasonographic (US) examinations (53 B-mode, and 31 Doppler Duplex) were performed, with few exceptions within 3 days. Angiography served as the 'gold standard'. Shunt patency was correctly interpreted as normal in B-mode US in 38 examinations. Shunt occlusion, definite or probable, was seen in 12 B-mode examinations, where angiography demonstrated occlusion in 6 and patency in the remaining 6 shunts. Shunt occlusion was not observed sonographically in one examination. US was technically inadequate on two occasions. Doppler Duplex showed shunt patency in all 31 examinations, which was correct according to angiography. Both B-mode US, in 6 out of 6 examinations, and Doppler Duplex, in 7 out of 9 examinations failed to reveal shunt stenosis. Five patients with abundant venous collaterals (in one case with aberrant vascular anatomy) were not possible to evaluate even after the introduction of Doppler Duplex, which otherwise facilitated the evaluation. We suggest that US including Doppler should be the primary modality for follow-up in patients with interposition mesocaval Goretex grafts.