The use and misuse of transjugular intrahepatic portasystemic shunts

Abstract

Transjugular intrahepatic portasystemic shunts, or TIPS, are used to create a low-resistance channel between the hepatic vein and the intrahepatic portion of the portal vein by deployment of an expandable metal stent. TIPS function like side-to-side surgical portacaval shunts, but their placement does not require anesthesia and major surgery. This article reviews the uses and misuses of TIPS in current practice. The uses include variceal hemorrhage and ascites as well as miscellaneous indications such as Budd-Chiari syndrome, veno-occlusive disease, bleeding ectopic and rectal varices, hepatic hydrothorax, and portal hypertensive gastropathy. TIPS is not indicated for primary prophylaxis of variceal hemorrhage, prehepatic portal hypertension, correction of hypersplenism and thrombocytopenia, pulmonary hypertension and hepatopulmonary syndrome, and portal hypertension associated with polycystic liver disease or Caroli's disease. Also reviewed herein is the management of patients after TIPS placement.

Hepatic hydrothorax: Pathophysiology diagnosis and management

“…The TIPS are created by the placement, under the fluoroscopic guidance of an expandable metal stent in the hepatic parenchyma between the portal and the hepatic venous system. Therefore, TIPS reduce portal pressure and address the elevated hepatic sinusoidal pressure that leads to ascites 55,56 …”

Child-Pugh versus MELD score in predicting survival in patients undergoing transjugular intrahepatic portosystemic shunt

“…[1][2][3][4][5][6] Patients undergoing TIPS belong to a subgroup of patients with advanced stage liver disease and at least one episode of severe decompensation. These patients have a poor prognosis.…”

Transjugular Intrahepatic Portosystemic Shunt for the Treatment of Portal Hypertension Due to Idiopathic Myelofibrosis

“…Platelets and megakaryocytes in the space of Disse in the liver ultrastructurally contain extramedullary hematopoiesis (3,9 (10,11). This is also a good method for managing portal hypertension in patients with IMF (6,12,13).…”