Discuss ARDMS AB-Abdomen Exam Topic 2 Question 12

Which sonographic finding is associated with normal postprocedural Doppler of a transjugular intrahepatic portosystemic shunt (TIPS)?

ATriphasic flow throughout stent

BLow-velocity flow throughout stent

CHepatofugal flow in the intrahepatic portal venous branches

DHepatopetal flow in the intrahepatic portal venous branches

Suggested Answer: D

After successful TIPS placement, the intrahepatic portal venous branches continue to exhibit hepatopetal (toward the liver) flow, while the stent itself shows continuous, relatively high-velocity monophasic flow. Hepatofugal flow in intrahepatic branches may indicate shunt dysfunction.

According to Zwiebel's Introduction to Vascular Ultrasound:

''Normal post-TIPS Doppler shows hepatopetal flow in the intrahepatic portal veins and continuous high-velocity flow within the stent.''

Zwiebel WJ, Pellerito JS. Introduction to Vascular Ultrasound. 6th ed. Elsevier, 2019.

AIUM Practice Parameter for the Performance of Portal Venous Ultrasound, 2020.

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24 comments · newest first

Denise 2 days ago

C seems off too.

Lasandra 7 days ago

Low-velocity flow isn't normal for TIPS.

Tamekia 12 days ago

But what about B?

Lasandra 17 days ago

Triphasic flow indicates normal function.

Denise 23 days ago

Why A?

Lasandra 28 days ago

I think A is the right answer.

Tamekia 1 month ago

This question is tricky!

Susana 1 month ago

Same here! It's all about understanding the hemodynamics.

Keith 1 month ago

I just hope I remember the flow patterns correctly!

Vernell 2 months ago

Good point! D could show proper blood flow direction.

Susana 2 months ago

I lean towards D. Hepatopetal flow indicates good function.

Vernell 2 months ago

True, but I remember low velocity can also indicate stability.

Keith 2 months ago

But A shows triphasic flow, which is ideal for TIPS.

Vernell 2 months ago

I feel like B might be the answer. Low velocity seems normal.

Keith 2 months ago

This question is tricky! I think it's A.

Catarina 3 months ago

Are we sure about A? Seems too straightforward.

Kenny 3 months ago

Wait, I’m surprised it’s not D) Hepatopetal flow.

Whitney 3 months ago

Definitely A! It’s a classic finding.

Shawna 3 months ago

I thought it was B) Low-velocity flow.

Roslyn 3 months ago

A) Triphasic flow throughout stent is the right answer!

Delisa 4 months ago

I definitely remember hepatofugal flow being a bad sign, but I’m confused about the other options and which one is truly normal.

Yuki 5 months ago

I feel like low-velocity flow might be a normal finding too, but it seems a bit counterintuitive.

Alecia 5 months ago

I think I came across a practice question that mentioned triphasic flow being a good sign, but I can't recall if that applies specifically to TIPS.

Chun 5 months ago

I remember studying that TIPS should ideally show hepatopetal flow in the portal branches, but I'm not entirely sure if that's the only indicator of normalcy.

ARDMS AB-Abdomen Exam - Topic 2 Question 12 Discussion