The use of intravascular ultrasound (IVUS) for direct portosystemic shunt (DIPS) evaluation

Abstract

AbstractA 32-year-old male with Budd-Chiari syndrome secondary to paroxysmal nocturnal haemoglobinuria (PNH) underwent direct portosystemic shunt (DIPS). The procedure was difficult, and after initial attempts without success via the internal jugular vein, a stent was placed with ultrasound (US) guidance via femoral approach. Unfortunately, following these two prolonged DIPS procedures, two weeks apart, the patient developed contrast-induced nephropathy, precluding further use of conventional contrast media and necessitating an alternative imaging modality to assess stent function. Transabdominal US was unable to clearly visualize the stent, so intravascular ultrasound (IVUS) was utilized. Good quality images were obtained and the stent's patency was accurately evaluated, identifying the presence of thrombus and leading to balloon angioplasty and improved flows. IVUS may be useful for DIPS stent evaluation.