Quality Improvement Guidelines for Transjugular Intrahepatic Portosystemic Shunts

Abstract

The membership of the Society of Interventional Radiology (SIR) Standards of Practice Committee represents experts in a broad spectrum of interventional procedures from the private and academic sectors of medicine. Generally, Standards of Practice Committee members dedicate the vast majority of their professional time to performing interventional procedures; as such, they represent a valid, broad expert constituency on the subject matter under consideration for standards production. METHODOLOGYSIR produces its Standards of Practice documents using the following process. Standards documents of relevance and timeliness are conceptualized by the Standards of Practice Committee members. A recognized expert is identified to serve as the principal author for the document. Additional authors may be assigned depending on the magnitude of the project.An in-depth literature search is performed with use of electronic medical literature databases. Then, a critical review of peer-reviewed articles is performed regarding the study methodology, results, and conclusions. The qualitative weight of these articles is assembled into an evidence table, which is used to write the document such that it contains evidence-based data with respect to content, rates, and thresholds.When the evidence of literature is weak, conflicting, or contradictory, consensus for the parameter is reached by a minimum of 12 Standards of Practice Committee members using a modified Delphi consensus method (Appendix A). For the purpose of these documents, consensus is defined as 80% Delphi participant agreement on a value or parameter.The draft document is critically reviewed by the Standards of Practice Committee members in a telephone conference call or face-toface meeting. The finalized draft from the Committee is sent to the SIR membership for further input/criticism during a 30-day comment period. These comments are discussed by the Standards of Practice Committee, and appropriate revisions are made to create the finished standards document. Before its publication, the document is endorsed by the SIR Executive Council.

Using transjugular intrahepatic portosystemic shunt as the first‐line therapy in secondary prophylaxis of variceal hemorrhage

“…Indicated by TIPS practice criteria, [15][16][17][18] TIPS insertion of all the patients were operated by one experienced interventional therapist. Indicated by TIPS practice criteria, [15][16][17][18] TIPS insertion of all the patients were operated by one experienced interventional therapist.…”

“…Transjugular intrahepatic portosystemic shunt procedures with assessment of treatment outcomes and follow up after treatment. Indicated by TIPS practice criteria, [15][16][17][18] TIPS insertion of all the patients were operated by one experienced interventional therapist. An 8-mm expandable PTFE-covered stent (Fluency, Bard Peripheral Vascular, Tempe, Arizona, USA) were inserted.…”

Diastolic dysfunction on echocardiography does not predict survival after transjugular intrahepatic portosystemic stent‐shunt in patients with cirrhosis

“…These include acute haemorrhage (arterial puncture, liver capsule transgression), liver and associated organ failure, hepatic encephalopathy, injury to surrounding organs, infection and stent complications (thrombosis, dysfunction, migration). In experienced hands the direct procedure‐related mortality is less than 2%, but the overall 30‐day mortality ranges vastly from 3% to 44%, depending on the clinical indication and condition of the patient pre‐TIPSS insertion …”

Hospital volume and mortality after transjugular intrahepatic portosystemic shunt creation in the United States

“…Transjugular intrahepatic portosystemic shunt (TIPS) placement for treating sequelae of portal hypertension requires a high degree of technical and clinical experience to achieve optimal patient outcomes . A recent study of the Nationwide Inpatient Sample (NIS) reported a reduction in inpatient mortality during admissions with TIPS placement from 12.5% in 2003 to 10.6% in 2012 .…”