Intrahepatic vascular shunts: Strategy for early diagnosis, evaluation and management

PurposeTo propose a strategy for early diagnosis and management of intrahepatic vascular shunts (IHVSs).Patients and MethodsWe systematically screened 3143 patients liable to develop IHVSs. Diagnosed patients were comprehensively evaluated using color Doppler and multiphasic CT. Our management strategy based on imaging and clinical findings and categorized patients into three groups with different lines of management and we assessed the degree of shunt occlusion and clinical outcome.ResultsIHVSs were diagnosed in 134 patients. Two types of shunts were identified; arteriovenous (72%) and venovenous (28%). Small simple shunts (32%) showed no morphological or hemodynamic changes. Small complex shunts (57%) showed mild alterations in Doppler spectra. Large and aneurismal shunts (11%) showed increased diameters and flow velocities of the shunt vessels with alteration of flow pattern. By CT the vessels opacified during the early arterial phases in arteriovenous, and during the portovenous phase in venovenous shunts. During management, group I included 42%; 38% were conservatively managed and 4% underwent TIPS. Group II included 57% who underwent successful embolization in 50%, and <80% reduction in 7% of patients who underwent surgery. Direct surgery was selected for 1% of patients.ConclusionUsing color Doppler ultrasonography complemented by multiphasic CT allowed early diagnosis and evaluation of IHVSs and selection of the suitable treatment. Our management strategy allowed practical therapeutic implications and yielded good results.