transjugular intrahepatic portosystemic shunt (TIPS)

Introduction

Interventional radiology technique.

Indications

• useful for relieving portal pressure in patients with
  • hepatic cirrhosis
  • gastric varices
  • esophageal varices
  • refractory ascites
• control refractory hemorrhage in candidates for liver transplantation

Clinical significance

• useful for patients who are poor surgical candidates
• success rate in control of esophageal varices is > 90%

Procedure

• angiographic placement of an expandandable metallic stent from a branch of the hepatic vein through the hepatic parenchyma into a branch of the portal vein
• rifaximin 600 mg bid starting 14 days prior to procedure & continuing for 6 months prevents hepatic encephalopathy

Complications

• shunt occlusion (50% in 1 year)
• increased risk of hepatic encephalopathy 15-25% (3-5% severe)
• morbidity of 20% & early mortality of 5%

Notes

• there is little evidence that TIPS improves mortality
• preemptive TIPS in patients with cirrhois & acute variceal hemorrhage improves survival
• recurrence of variceal bleeding after TIPS is almost always caused by stenosis or occlusion of the shunt

More general terms

• vascular surgery