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Transjugular Intrahepatic Portosystemic Shunt: TIPS

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PanVascular Medicine

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Abstract

TIPS is a nonsurgical procedure that creates a portosystemic shunt percutaneously. It is used to treat complications of portal hypertension, mainly bleeding from gastroesophageal varices and refractory ascites unresponsive to medical therapy. The principles and short history of TIPS are presented and then the current status of TIPS is discussed. Included are TIPS indications, contraindications, patient selection, and a detailed description of the procedural technique. Important aspects of the procedural technique deserving emphasis are placed on knowledge of hepatic and portal vascular anatomy, careful establishment of portal vein access, correct placement of the stentgraft, and stentgraft expansion to achieve the optimal gradient between the portal and systemic venous circulations. Variceal embolization during TIPS for patients with fresh or recent variceal bleeding is also described. Finally, potential complications and techniques to prevent them are discussed. Performed by experienced interventionalists, TIPS is a safe and effective procedure. Complications occur when proper technique is not used. With stentgrafts, TIPS achieves immediate hemostasis in about 95 % of patients with variceal hemorrhage and decreases tense ascites in a mean of 60 % of patients. Properly placed stentgrafts stay patent without formation of intimal hyperplasia. TIPS, however does lead to new or exacerbation of preexisting hepatic encephalopathy in about 30 % of patients.

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Abbreviations

Angioplasty balloon catheter:

Catheter with a balloon at the end used to dilate narrowings in vessels.

Budd-Chiari Syndrome:

Thrombosis of hepatic veins with great enlargement of the liver, extensive development of collateral vessels, severe portal hypertension and ascites.

Coagulopathy:

Impaired blood’s ability to clot.

Hepatic encephalopathy:

Brain disorder arising from advanced liver disease due to increased blood ammonia levels.

Hepato Renal Syndrome:

Occurrence of renal failure in patients with liver disease.

Meta-analyses:

Methods focusing on comparing and contrasting results from different studies.

Paracentesis:

Relief of abdominal ascitic fluid by introduction of a needle or catheter into the peritoneal space and aspiration of ascetic fluid.

Pigtail catheter:

Catheter with peripheral end shaped like a pigtail.

Portal vein:

Main blood vessel conducting blood from gastrointestinal tract and spleen to the liver.

Refractory:

Resistant to treatment.

Sclerotherapy:

Treatment of enlarged blood vessels or vessel malformations by injecting a medicine causing sclerosis.

Sotradecol:

Sclerosing agent.

Stent:

Percutaneously placed scaffold-like device within the vascular lumen to increase its diameter.

Stent graft:

Stent covered with nonporous layer of material to prevent bile duct and liver growth into its lumen.

References

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Further Reading

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Authors and Affiliations

  1. Dotter Interventional Institute, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, 342, Portland, OR, USA

    Josef Rösch M.D., Frederick S. Keller M.D. & John A. Kaufman M.D.

Authors
  1. Josef Rösch M.D.
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  2. Frederick S. Keller M.D.
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  3. John A. Kaufman M.D.
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Corresponding author

Correspondence to Josef Rösch M.D. .

Editor information

Editors and Affiliations

  1. Akademisches Lehrkrankenhaus MLU, Bitterfeld-Wolfen, Germany

    Peter Lanzer

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© 2014 Springer-Verlag Berlin Heidelberg

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Rösch, J., Keller, F.S., Kaufman, J.A. (2014). Transjugular Intrahepatic Portosystemic Shunt: TIPS. In: Lanzer, P. (eds) PanVascular Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-37393-0_128-1

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  • DOI: https://doi.org/10.1007/978-3-642-37393-0_128-1

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Online ISBN: 978-3-642-37393-0

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