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The use and misuse of transjugular intrahepatic portasystemic shunts

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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-occulsive disease, bleeding ectopic and rectal varices, hepatic hydrothorax, and portal hypertensive gastropathy. TIPS is not indicated for primary prophylaxis of variceal hemorrage, 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.

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References and Recommended Reading

  1. Grace N: The side-to-side portacaval shunt revisited. N Engl J Med 1994, 330:208.

    Article  PubMed  CAS  Google Scholar 

  2. Prandi D, Rueff B, Roche-Sicot J, et al.: Life-threatening hemorrhage of the digestive tract in cirrhotic patients. Am J Surg 1976, 131:204–209.

    Article  PubMed  CAS  Google Scholar 

  3. deFranchis R, Primignani M: Why do varices bleed? Gastroenterol Clin N Am 1992, 21:85–101.

    CAS  Google Scholar 

  4. Graham DY, Smith JL. The course of patients after variceal hemorrhage. Gastroenterology 1981, 80:800–809.

    PubMed  CAS  Google Scholar 

  5. Smith JL, Graham DY. Variceal hemorrhage: a critical evaluation of survival analysis. Gastroenterology 1982, 82:968–973.

    PubMed  CAS  Google Scholar 

  6. D'Amico G, Morabito A, Pagliaro L: Six week prognostic indicators in upper gastrointestinal hemorrhage in cirrhotics. Front Gastrointest Res 1986, 9:247–258.

    Google Scholar 

  7. The Copenhagen Esophageal Varices Sclerotherapy Project: Sclerotherapy after first variceal hemorrhage in cirrhosis. N Engl J Med 1984, 311:1594–1600.

    Article  Google Scholar 

  8. Soderlund C, Ihre T: Endoscopic sclerotherapy vs conservative management of bleeding oesophageal varices. Acta Chir Scand 1985, 151:449–456.

    PubMed  CAS  Google Scholar 

  9. Barsoum MS, Bolous FI, El-Rooby A, et al.: Tamponade and injection sclerotherapy in the management of bleeding oesophageal varices. Br J Surg 1982, 69:76–78.

    Article  PubMed  CAS  Google Scholar 

  10. Cello JP, Grendell JH, Crass RA, et al.: Endoscopic sclerotherapy versus portacaval shunt in patients with severe cirrhosis and variceal hemorrhage. N Engl J Med 1984, 311:1589–1594.

    Article  PubMed  CAS  Google Scholar 

  11. Planas R, Quer JC, Boix J, et al.: A prospective randomized trial comparing somatostatin and sclerotherapy in the treatment of acute variceal bleeding. Hepatology 1994, 20:370–375.

    PubMed  CAS  Google Scholar 

  12. Freedman AM, Sanyal AJ, Tisnado J, et al.: Complications of transjugular intrahepatic porto-systemic shunt (TIPS): a comprehensive review. Radiographics 1993, 13:1185–1210.

    PubMed  CAS  Google Scholar 

  13. Grace ND: Diagnosis and treatment of gastrointestinal bleeding secondary to portal hypertension: American College of Gastroenterology Practice Parameters Committee. Am J Gastroenterol 1997, 92:1081–1091.

    PubMed  CAS  Google Scholar 

  14. Villeneuve JP, Pomier-Layrargues G, Duguay L, et al.:Emergency portacaval shunt for variceal hemorrhage: a prospective study. Ann Surg 1987, 206:48–52.

    Article  PubMed  CAS  Google Scholar 

  15. Stein C, Korula J: Variceal bleeding. What are the treatment options? Postgrad Med 1995, 98:143–149.

    PubMed  CAS  Google Scholar 

  16. Rikkers L, Gongliang J, Burnett DA, et al.: Shunt surgery versus endoscopic sclerotherapy for variceal hemorrhage: late results of a randomized trial. Am J Surg 1993, 165:27–33.

    Article  PubMed  CAS  Google Scholar 

  17. Soutter DI, Langer B, Taylor BR, Greig P: Emergency portosystemic shunting in cirrhotics with bleeding varices: a comparison of portacaval shunts and mesocaval shunts. HPB Surg 1989, 1:107–111.

    PubMed  CAS  Google Scholar 

  18. Orloff MJ, Bell RH, Hyde PV, Skivolocki WP: Long-term results of emergency portacaval shunt for bleeding esophageal varices in unselected patients with alcoholic cirrhosis. Ann Surg 1980, 192:325–339.

    Article  PubMed  CAS  Google Scholar 

  19. Rikkers LF, Jin G: Emergency shunt: role in the present management of variceal bleeding. Arch Surg 1995, 130:472–477.

    PubMed  CAS  Google Scholar 

  20. Rikkers LF, Jin G: Surgical management of acute variceal hemorrhage. World J Surg 1994, 18:193–199.

    Article  PubMed  CAS  Google Scholar 

  21. LaBerge JM, Ring EJ, Gordon RL, et al.: Creation of transjugular intrahepatic portosystemic shunts with the wallstent endoprosthesis: results in 100 patients. Radiology 1993, 187:413–420.

    PubMed  CAS  Google Scholar 

  22. Rossle M, Haag K, Ochs A, et al.: The transjugular intrahepatic portosystemic stent-shunt procedure for variceal hemorrhage. N Engl J Med 1994, 330:165–171.

    Article  PubMed  CAS  Google Scholar 

  23. Sanyal AJ, Freedman AM, Luketic VA, et al.: Transjugular intrahepatic portosystemic shunts for patients with active variceal hemorrhage unresponsive to sclerotherapy. Gastroenterology 1996, 111:138–146.

    Article  PubMed  CAS  Google Scholar 

  24. Jalan R, John TG, Redhead DN, et al.: A comparative study of emergency transjugular intrahepatic portosystemic stent-shunt and esophageal transection in the management of uncontrolled variceal hemorrhage [see comments]. Am J Gastroenterol 1995, 90:1932–1937.

    PubMed  CAS  Google Scholar 

  25. Cao S, Monge H, Semba C, et al.: Emergency transjugular intrahepatic portosystemic shunt (TIPS) in an infant: a case report. J Pediatr Surg 1997, 32:125–127.

    Article  PubMed  CAS  Google Scholar 

  26. Chau TN, Patch D, Chan YW, et al.: “Salvage” transjugular intrahepatic portasystemic shunts: gastric fundal compared with esophageal variceal bleeding. Gastroenterology 1998, 114:981–987.

    PubMed  CAS  Google Scholar 

  27. Barange K, Rousseau H, Vinel JP: Intrahepatic porto-systemic shunt in the treatment of hemorrhage in portal hypertension. Presse Med 1997, 26:1162–1167.

    PubMed  CAS  Google Scholar 

  28. Rosemurgy AS, Goode SE, Zwiebel BR, et al.: A prospective trial of transjugular intrahepatic portasystemic stent shunts versus small-diameter prosthetic H-graft portacaval shunts in the treatment of bleeding varices [see discussion). Ann Surg 1996, 224:378–384.

    Article  PubMed  CAS  Google Scholar 

  29. Sanyal AJ, Freedman AM, Luketic VA, et al.: The natural history of portal hypertension after transjugular intrahepatic portosystemic shunts [comment]. Gastroenterology 1997, 112:889–98. Report from a long-term follow-up study of 100 consecutive patients undergoing TIPS. The natural history of such patients, the causes of recurrent portal hypertension, and the value of Doppler sonography and endoscopy for the detection of TIPS stenosis are evaluated.

    Article  PubMed  CAS  Google Scholar 

  30. Sarin SK, Lahoti D, Saxena SP, et al.: Prevalence, classification and natural history of gastric varices: long-term follow up study in 568 patients with portal hypertension. Hepatology 1992, 95:434–440.

    Google Scholar 

  31. Sarin SK: Diagnostic issues: portal hypertensive gastropathy and gastric varices. In Proceedings of the Second Baveno International Consensus Workshop on Definitions, Methodology and Therapeutic Strategies: Portal Hypertension II, vol 3. Edited by DeFranchis R. Oxford: Blackwell Science; 1996:30–55.

    Google Scholar 

  32. Rubin RA, O'Brien C, Haskal ZJ, et al.: Decreased survival following transjugular intrahepatic portosystemic shunting for Child C patients with high Apache II scores. Am J Gastroenterol 1995, 90:556–563.

    PubMed  CAS  Google Scholar 

  33. Burroughs AK, Jenkins WJ, Sherlock S, et al.: Controlled trial of propranolol for the prevention of recurrent variceal hemorrhage in patients with cirrhosis. N Engl J Med 1983, 309:1539–1542.

    Article  PubMed  CAS  Google Scholar 

  34. Sanyal AJ, Freedman AM, Luketic VA, et al.: Transjugular intrahepatic portosystemic shunts compared with endoscopic sclerotherapy for the prevention of recurrent variceal hemorrhage: a randomized, controlled trial [see comments]. Ann Intern Med 1997, 126:849–857.

    PubMed  CAS  Google Scholar 

  35. Cello JP, Ring EJ, Olcott EW, et al.: Endoscopic sclerotherapy compared with percutaneous transjugular intrahepatic portosystemic shunt after initial sclerotherapy in patients with acute variceal hemorrhage: a randomized, controlled trial [see comments]. Ann Intern Med 1997, 126:858–865.

    PubMed  CAS  Google Scholar 

  36. Cabrera J, Maynar M, Granados R, et al.: Transjugular intrahepatic portosystemic shunt versus sclerotherapy in the elective treatment of variceal hemorrhage. Gastroenterology 1996, 10:832–39.

    Article  Google Scholar 

  37. Rossle M, Deibert P, Haag K, et al.: Randomised trial of transjugular-intrahepatic-portosystemic shunt versus endoscopy plus propranolol for prevention of variceal rebleeding. Lancet 1997, 349:1043–1049.

    Article  PubMed  CAS  Google Scholar 

  38. Sanyal AJ, Freedman AM, Shiffman ML, et al.: Portosystemic encephalopathy after transjugular intrahepatic portosystemic shunt: results of a prospective controlled study. Hepatology 1994, 20:46–55.

    PubMed  CAS  Google Scholar 

  39. Pomier-Layrargues G: TIPS and hepatic encephalopathy. Semin Liver Dis 1996, 16:315–320.

    PubMed  CAS  Google Scholar 

  40. Sahagun G, Benner KG, Saxon R, et al.: Outcome of 100 patients after transjugular intrahepatic portosystemic shunt for variceal hemorrhage [see comments]. Am J Gastroenterol 1997, 92:1444–1452.

    PubMed  CAS  Google Scholar 

  41. LaBerge JM, Somberg KA, Lake JR, et al.: Two-year outcome following transjugular intrahepatic portosystemic shunt for variceal bleeding: results in 90 patients. Gastroenterology 1995, 108:1143–1151.

    Article  PubMed  CAS  Google Scholar 

  42. Runyon B: Refractory ascites. Semin Liver Dis 1993, 13:343–351.

    PubMed  CAS  Google Scholar 

  43. Gines P, Quintero E, Arroyo V, et al.: Compensated cirrhosis: natural history and prognostic factors. Hepatology 1987, 7:122–128.

    Article  PubMed  CAS  Google Scholar 

  44. Arroyo V, Gines P, Gerbes AL, et al., for the International Ascites Club: Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. Hepatology 1996, 23:164–176.

    Article  PubMed  CAS  Google Scholar 

  45. Gines A, Escorsell A, Gines P, et al.: Incidence, predictive factors and prognosis of the HRS in patients with liver cirrhosis and ascites with and without functional renal failure. Gastroenterology 1993, 105:229–236.

    PubMed  CAS  Google Scholar 

  46. Quiroga J, Sangro B, Nunez M, et al.: Transjugular intrahepatic portal-systemic shunt in the treatment of reractory ascites: effect on clinical, renal, humaoral and hemodynamic parameters. Hepatology 1995, 21:986–994.

    PubMed  CAS  Google Scholar 

  47. Somberg K, Lake JR, Tomlanovich SJ, et al.: Transjugular intrahepatic portosystemic shunts for refractory ascites: assessment of clinical and hormonal response and renal function. Hepatology 1995, 21:709–716.

    PubMed  CAS  Google Scholar 

  48. Wong F, Sniderman K, Liu P, et al.: Transjugular intrahepatic portosystemic stent shunt: effects on hemodynamics and sodium homeostasis in cirrhosis and refractory ascites. Ann Intern Med 1995, 122:816–822.

    PubMed  CAS  Google Scholar 

  49. Ferral H, Bjarnson H, Wegryn SA, et al.: Refractory ascites: early experience in treatment with transjugular intrahepatic portosystemic shunt. Radiology 1993, 189:795–801.

    PubMed  CAS  Google Scholar 

  50. Ochs A, Rossle M, Haag K, et al.: The transjugular intrahepatic portosystemic stent-shunt procedure for refractory ascites. N Engl J Med 1995, 332:1192–1197.

    Article  PubMed  CAS  Google Scholar 

  51. Martinet JP, Fenyves D, Legault L, et al.: Treatment of refractory ascites using transjugular intrahepatic portosystemic shunt (TIPS): a caution. Dig Dis Sci 1997 42:161–166.

    Article  PubMed  CAS  Google Scholar 

  52. Lebrec D, Giuily N, Hadengue A, et al.: Transjugular intrahepatic portosystemic shunts: comparison with paracentesis in patients with cirrhosis and refractory ascites: a randomized trial by the French Group of Clinicians and a Group of Biologists. J Hepatol 1996, 25:135–144.

    Article  PubMed  CAS  Google Scholar 

  53. Ochs A, Gerbes AL, Haag K, et al.: TIPS and paracentesis for the treatment of refractory ascites (RA): interim analysis of a randomized controlled trial [abstract]. Hepatology 1995, 22:297A.

    Google Scholar 

  54. Wong F, Blendis L: Transjugular intrahepatic portosystemic shunt: is it the ultimate solution for refractory ascites? Hepatology 1995, 22:1613–1615.

    PubMed  CAS  Google Scholar 

  55. Dolz C, Raurich JM, Ibanez J, et al.: Ascites increases resting energy expenditure. Gastroenterology 1991, 100:738–744.

    PubMed  CAS  Google Scholar 

  56. Akerman PA, Jenkins RL, Bistrian BR: Preoperative nutrition assessment in liver transplantation. Nutrition 1993, 9:350–356.

    PubMed  CAS  Google Scholar 

  57. Brensing KA, Textor J, Strunk H, et al.: Transjugular intrahepatic portosystemic stent-shunt for hepatorenal syndrome [letter]. Lancet 1997, 349:697–698.

    Article  PubMed  CAS  Google Scholar 

  58. Roberts LR, Kamath PS: Ascites and hepatorenal syndrome: pathophysiology and management. Mayo Clin Proc 1996, 71:874–881.

    PubMed  CAS  Google Scholar 

  59. Lerut J, Goffette P, Laterre PF, et al.: Sequential treatment of hepatorenal syndrome and posthepatic cirrhosis by intrahepatic portosystemic shunt (TIPS) and liver transplantation. Hepatogastroenterology 1995, 42:985–987.

    PubMed  CAS  Google Scholar 

  60. Rossle M, Haag K, Ochs A, et al.: The transjugular intrahepatic portosystemic stent-shunt procedure for variceal bleeding [see comments]. N Engl J Med 1994, 330:165–171.

    Article  PubMed  CAS  Google Scholar 

  61. Somberg KA: Transjugular intrahepatic portosystemic shunt for refractory ascites: shunt diameter-optimizing risks and benefits [letter]. Hepatology 1997, 25:254–255.

    Article  PubMed  CAS  Google Scholar 

  62. Levy M: Sodium retntion and ascites formation in dogs with experimental portal cirrhosis. Am J Physiol 1977, 233:F572-F585.

    PubMed  CAS  Google Scholar 

  63. Murphy FB, Steinberg HV, Shires GTI, et al.: The Budd-Chiari Syndrome: a review. Am J Roentgenol 1986, 147:9–15.

    CAS  Google Scholar 

  64. Ringe B, Lang H, Oldhafer KJ, et al.: Which is the best surgery for Budd-Chiari syndrome: venous decompression or liver transplantation? A single-center experience with 50 patients. Hepatology 1995, 21:1337–1344.

    PubMed  CAS  Google Scholar 

  65. Ochs A, Sellinger M, Haag K, et al.: Transjugular intrahepatic portosystemic stent-shunt (TIPS) in the treatment of Budd-Chiari syndrome. J Hepatol 1993, 18:217–225.

    Article  PubMed  CAS  Google Scholar 

  66. Peltzer MY, Ring EJ, LaBerge JM, et al.: Treatment of Budd-Chiari syndrome with a transjugular intrahepatic portosystemic shunt. J Vasc Interv Radiol 1993, 4:263–267.

    PubMed  CAS  Google Scholar 

  67. Lopez RR, Benner KG, Hall L, et al.: Expandable venous stents for treatment of the Budd-Chiari syndrome. Gastroenterology 1991, 100:1435–1441.

    PubMed  Google Scholar 

  68. Fried MW, Connaghan DG, Sharma S, et al.: Transjugular intrahepatic portosystemic shunt for the management of severe venoocclusive disease following bone marrow transplantation. Hepatology 1996, 24:588–591.

    Article  PubMed  CAS  Google Scholar 

  69. Bernstein D, Yrizarry J, Reddy KR, et al.: Transjugular intrahepatic portosystemic shunt in the treatment of intermittently bleeding stomal varices. Am J Gastroenterol 1996, 91:2237–2238.

    PubMed  CAS  Google Scholar 

  70. Allgaier HP, Ochs A, Haag K, et al.: Recurrent bleeding from colonic varices in portal hypertension: the successful prevention of recurrence by the implantation of a transjugular intrahepatic stent-shunt (TIPS). Dtsch Med Wochenschr 1995, 120:1773–1776.

    PubMed  CAS  Google Scholar 

  71. Andrade RJ, Martin-Palanca A, Fraile JM, et al.: Transjugular intrahepatic portosystemic shunt for the management of hepatic hydrothorax in the absence of ascites. J Clin Gastroenterol 1996, 22:305–307.

    Article  PubMed  CAS  Google Scholar 

  72. Haskal ZJ, Zuckerman J: Resolution of hepatic hydrothorax after transjugular intrahepatic portosystemic shunt (TIPS) placement. Chest 1994, 106:1293–1295.

    PubMed  CAS  Google Scholar 

  73. Gordon FD, Anastopoulos HT, Crenshaw W, et al.: The successful treatment of symptomatic, refractory hepatic hydrothorax with transjugular intrahepatic portosystemic shunt. Hepatology 1997, 25:1366–1369.

    Article  PubMed  CAS  Google Scholar 

  74. Chalasani N, Martin LG, Strauss RM, Boyer TD.: Transjugular intrahepatic portasystemic shunts (TIPS) for refractory hepatic hydrothorax (HHT): good for the lungs, not so good for the liver [abstract]. Hepatology 1997, 26:287A.

    Article  Google Scholar 

  75. Peine CJ, Freeman ML, Miller RP, et al.: Resolution of congestive gastropathy using transjugular intrahepatic portosystemic stents [abstract]. Hepatology 1992, 16:245A.

    Article  Google Scholar 

  76. Abouljoud MS, Levy MF, Rees CR, et al.: A comparison of treatment with transjugular intrahepatic portosystemic shunt or distal splenorenal shunt in the management of variceal bleeding prior to liver transplantation. Transplantation 1995, 59:226–229.

    Article  PubMed  CAS  Google Scholar 

  77. Somberg KA, Lombardero MS, Lawlor SM, et al.: A controlled analysis of the transjugular intrahepatic portosystemic shunt in liver transplant recipients: the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Liver Transplantation Database. Transplantation 1997, 63:1074–1079.

    Article  PubMed  CAS  Google Scholar 

  78. Hanig V, Stenzel G, Rossle M: Acute portal vein thrombosis in liver cirrhosis: successful recanalization with the use of a portosystemic shunt (TIPS). Rofo Fortschr Geb Rontgenstr. Neuen Bildgeb Verfahr 1996, 165:403–405.

    CAS  Google Scholar 

  79. Radosevich PM, Ring EJ, LaBerge JM, et al.: Transjugular intrahepatic portosystemic shunts in patients with portal vein occlusion. Radiology 1993, 186:523–527.

    PubMed  CAS  Google Scholar 

  80. Peck-Radosavljevic M, Zacherl J, Meng YG, et al.: Is inadequate thrombopoietin production a major cause of thrombocytopenia in cirrhosis of the liver? J Hepatol 1997, 27:127–131.

    Article  PubMed  CAS  Google Scholar 

  81. Alvarez OA, Lopera GA, Patel V, et al.: Improvement of thrombocytopenia due to hypertension after transjugular intrahepatic portosystemic shunt placement in cirrhotic patients. Am J Gastroenterol 1996, 91:134–137.

    PubMed  CAS  Google Scholar 

  82. Lawrence SP, Lezotte DC, Durham JD, et al.: Course of thrombocytopenia of chronic liver disease after transjugular intrahepatic portosystemic shunts (TIPS): a retrospective analysis. Dig Dis Sci 1995, 40:1575–1580.

    Article  PubMed  CAS  Google Scholar 

  83. Pursnani KG, Sillin LF, Kaplan DS: Effect of transjugular intrahepatic portosystemic shunt on secondary hypersplenism. Am J Surg 1997, 173:169–173.

    Article  PubMed  CAS  Google Scholar 

  84. Sanyal AJ, Freedman AM, Purdum PP, et al.: The hematologic consequences of transjugular intrahepatic portosystemic shunts [see comments]. Hepatology 1996, 23:32–39.

    Article  PubMed  CAS  Google Scholar 

  85. Mutchnick MG, Lerner E, Conn HO: Effect of portacaval anastomosis on hypersplenism. Dig Dis Sci 1980, 25:929–938.

    Article  PubMed  CAS  Google Scholar 

  86. Felix Jr WR, Myerson RM, Sigel B, Jackson FC: The effect of portacaval shunt on hypersplenism. SGO 1974, 139:899–904

    PubMed  Google Scholar 

  87. Hadengue A, Benhayoun MK, Lebrec D, Benhamou J: Pulmonary hypertension complicating portal hypertension: prevalence and relation to splanchnic hemodynamics. Gastroenterology 1991, 100:520–528.

    PubMed  CAS  Google Scholar 

  88. Azoulay D, Castaing D, Dennison A, et al.: Transjugular intrahepatic portosystemic shunt worsens the hyperdynamic circulatory state of the cirrhotic patient: a preliminary report of a prospective study. Hepatology 1994, 19:129–132.

    PubMed  CAS  Google Scholar 

  89. Colombato LA, Spahr L, Martinet JP, et al.: Haemodynamic adaptation two months after transjugular intrahepatic portosystemic shunt (TIPS) in cirrhotic patients. Gut 1996, 39:600–604.

    PubMed  CAS  Google Scholar 

  90. Rodriguez-Laiz JM, Banares R, Echenagusia A, et al.: Effects of transjugular intrahepatic portasystemic shunt (TIPS) on splanchnic and systemic hemodynamics, and hepatic function in patients with portal hypertension: preliminary results. Dig Dis Sci 1995, 40:2121–2127.

    Article  PubMed  CAS  Google Scholar 

  91. van der Heijde RM, Lameris JS, van den Berg B, et al.: Pulmonary hypertension after transjugular intrahepatic portosystemic shunt (TIPS). Eur Respir J 1996, 9:1562–1564.

    Article  PubMed  Google Scholar 

  92. Willoughby PH, Beers RA, Murphy KD: Pulmonary edema after transjugular intrahepatic portosystemic shunt [letter]. Anesth Analg 1996, 82:895–896.

    Article  PubMed  CAS  Google Scholar 

  93. Shiffman ML, Jeffers L, Hoofnagle JH, Tralka TS: The role of transjugular intrahepatic portosystemic shunt (TIPS) for treatment of portal hypertension and its complications. Hepatol 1995, 22:1591–1597.

    Article  CAS  Google Scholar 

  94. Haskal ZJ, Pentecost MJ, Soulen MC, et al.: Transjugular intrahepatic portosystemic shunt stenosis and revision: early and midterm results. Am J Roentgenol 1994, 163:439–444.

    CAS  Google Scholar 

  95. Theilman L, Sauer P, Roeren T, et al.: Acetylsalicylic acid in the prevention of early stenosis and occlusion of transjugular intrahepatic portal-systemic stent shunts: a controlled study. Hepatology 1994, 20:592–598.

    Google Scholar 

  96. Jalan R, Forrest EH, Stanley AJ, et al.: A randomized trial comparing transjugular intrahepatic portosystemic stent-shunt with variceal band ligation in the prevention of rebleeding from esophageal varices. Hepatology 1997, 5:1115–1122.

    Google Scholar 

  97. Merli M, Salerno F, Riggio O, et al.: Transjugular intrahepatic portosystemic shunt versus endoscopic sclerotherapy for the prevention of variceal bleeding in cirrhosis: a randomized multicenter trial. Gruppo Italiano Studio TIPS (GIST). Hepatology 1998, 27:48–53.

    Article  PubMed  CAS  Google Scholar 

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  1. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical College of Virginia Campus of the Virginia Commonwealth University, MCV Box 980341, 23298-0341, Richmond, VA, USA

    Arun J. Sanyal MBBS, MD

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Sanyal, A.J. The use and misuse of transjugular intrahepatic portasystemic shunts. Curr Gastroenterol Rep 2, 61–71 (2000). https://doi.org/10.1007/s11894-000-0053-5

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