A composite Doppler ultrasound score for early identification of TIPS dysfunction in cirrhosis

Transjugular intrahepatic portosystemic shunt (TIPS) is an established treatment for portal hypertension complications, but efficacy may be limited by shunt dysfunction. This study evaluated the utility of early post-procedural Doppler ultrasound for detecting TIPS dysfunction in patients with cirrhosis.

This prospective single-centre observational study included patients with cirrhosis undergoing TIPS placement at Padova University Hospital between December 2023 and September 2025 and had Doppler ultrasound examination in 8-30 days after procedure. Doppler assessment included intra-shunt flow and flow direction in intrahepatic portal branches. Early TIPS dysfunction was angiographically defined. A composite Doppler ultrasound score incorporated three parameters: detectable intra-stent flow, hepatofugal flow in right and left intrahepatic portal branches, separately. For ROC analysis, the score was inverted: higher values indicated higher probability of TIPS dysfunction.

Sixty-nine patients were included. The first ultrasound examination was performed after a median of 21 days from TIPS placement. Early TIPS dysfunction was confirmed in 5 patients (7.2%). These patients showed significantly lower median intra-shunt flow velocity and less frequent hepatofugal flow in the left and, more markedly, in the right intrahepatic portal branches. The composite score showed good discriminatory performance for early TIPS dysfunction. Using an abnormal composite score > = 1, sensitivity was 80.0%, specificity 87.5%, positive predictive value 33.3%, and negative predictive value 98.2%.

A composite Doppler ultrasound score based on intra-shunt flow and intrahepatic portal branch flow direction showed good rule-out performance for early TIPS dysfunction. Because of the limited number of dysfunction events, these findings require validation in larger cohorts.