Transjugular intrahepatic portosystemic shunt (TIPS)

A created connection between the liver and the portal and systemic circulations.

Reduces portal pressure in patients with complications of portal hypertension.

Less invasive alternative to surgical attempts to lower portal hypertension.

Diverts portal blood into the hepatic vein and reduces the pressure gradient between the portal and systemic circulations.

Utilizes an expandable metal stent across the intrahepatic tract.

United States Disease Advisory Board recommends placement of this shunt for: acute esophageal variceal bleed that cannot be controlled with medical measures and recurrent and refractory variceal bleeding in patients that cannot tolerate usual medical measures.

Absolute contraindications to the procedure include the presence of right heart failure, polycentric liver disease, and severe hepatic failure.

Relative contraindications include active intrahepatic or systemic infection, severe hepatic encephalopathy, hypervascular hepatic tumors and portal vein thrombosis.

The use of polytetrafluoroethylene covered stents results in decreased incidence of hepatic encephalopathy.

Patients undergoing the procedure receive broad spectrum antibiotics.

Portal vein patency must be confirmed prior to TIPS placement.

Most placements can be achieved under intravenous conscious sedation, although many institutions utilize general anesthesia.

In patients with high risk for variceal bleeding with cirrhosis and hepatic venous pressure gradient of 20 mm Hg or more early treatment with TIPS improved the prognosis compared to conventional medical therapy (Monescillo E).

The use of extended polytetrafluoroethylene covered stents is associated with reductions in the incidence of TIPS dysfunction and recurrence of complications related to portal hpertension (Bureau C).

In patients with cirrhosis hospitalized for acute variceal bleeding and at high risk for treatment failure, the early use of TIPS is associated with significant reductions in treatment failure and mortality (Garcia-Pagan JC).

TIPS is contraindicated in congestive heart failure, severe pulmonary hypertension, and tricuspid regurgitation due to the increased cardiac venous return associated with the procedure.

TIPS is avoided in patients with underlying hepatic encephalopathy, as that complication is reported as many as 45% of patients.

Leave a Reply

Your email address will not be published. Required fields are marked *