Transjugular intrahepatic portosystemic shunts (TIPS) involve creation of a low-resistance channel between the hepatic vein and the intrahepatic portion of the portal vein using angiographic techniques.
The indications for TIPS include bleeding refractory to endoscopic and medical management, refractory ascities, Budd–Chiari syndrome, and hepatorenal syndromes.
The stent is expanded to a diameter that reduces the porto-sytemic gradient to less than 12 mm Hg.
TIPS is associated with post-procedure encephalopathy rates of approximately 25%, and patients with renal insufficiency are at risk for worsened renal function.
The long-term problem with TIPS is stenosis of the shunt, which is reported in as many as two thirds of patients. Most centers advocate an aggressive Doppler ultrasound monitoring program with prompt balloon dilation for identified stenosis of the stent.
REFERENCE:
Boyer TD, Haskal ZJ, American Association for the Study of Liver Diseases (2010) The role of transjugular intrahepatic portosystemp shunt (TIPS) in the management of portal hypertension: update 2009. Hepatology 51, 306.
Mulholland MW, Lillemoe KD, Doherty G et al. (2010) Greenfield’s Surgery: Scientific Principles and Practice, Lippincott Williams & Wilkins, Philadelphia, PA.
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