Transjugular intrahepatic portosystemic shunt (TIPS): current indications

  • Ziad Hassoun
  • Gilles Pomier-Layrargues
Conference paper


The transjugular intrahepatic portosystemic shunt (TIPS) is a new nonsurgical therapeutic modality used to treat complications of portal hypertension1, 2. It allows the creation of a communication between one hepatic vein and an intrahepatic branch of the portal vein by using a transjugular approach. The first TIPS implantation was reported in 1989 by Ritcher et al3; it is a hemodynamic equivalent of the small-diameter side-to-side surgical portacaval shunt. This procedure has been widely used all around the world for more than 15 years. After an initial wave of enthusiasm its exact place in the treatment of portal hypertension is now better defined as clinical controlled trials are available for the main potential indications. The major drawbacks of TIPS are stent dysfunction and hepatic encephalopathy, but progress has been made to decrease their clinical impact.


Portal Hypertension Transjugular Intrahepatic Portosystemic Shunt Gastric Varix Refractory Ascites Hepatopulmonary Syndrome 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Boyer TD. Transjugular intrahepatic portosystemic shunt: current status. Gastroenterology. 2003;124:1700–10.PubMedCrossRefGoogle Scholar
  2. 2.
    Rosado B, Kamath KP. Transjugular intrahepatic portosystemic shunts: an update. Liver Transplant. 2003;9:207–17.CrossRefGoogle Scholar
  3. 3.
    Richter GM, Palmaz JC, Noldge G et al. The transjugular intrahepatic portosystemic stentshunt. A new nonsurgical percutaneous method. Radiologe. 1989;29:406–11.PubMedGoogle Scholar
  4. 4.
    Radosevich PM, Ring EJ, Laberge JM et al. Transjugular intrahepatic portosystemic shunts in patients with portal vein occlusion. Radiology. 1993;186:523–27.PubMedGoogle Scholar
  5. 5.
    Freedman AM, Sanyal AJ, Tisnado J et al. Complications of transjugular intrahepatic portosystemic shunt: a comprehensive review. Radiographics. 1993;13:1185–210.PubMedGoogle Scholar
  6. 6.
    Spahr L, Sahai A, Lahaie R et al. Transient healing of a TIPS-induced biliovenous fistula by a PTFE-covered stent graft. Dig Dis Sci. 1996;41:2229–32.PubMedCrossRefGoogle Scholar
  7. 7.
    Pomier-Layrargues G. TIPS and hepatic encephalopathy. Semin Liver Dis. 1996;16:315–20.PubMedCrossRefGoogle Scholar
  8. 8.
    Casado M, Bosch J, Garcia-Pagan J et al. Clinical events after transjugular intrahepatic portosystemic shunt: correlation with hemodynamic findings. Gastroenterology. 1998;114: 1296–303.PubMedCrossRefGoogle Scholar
  9. 9.
    Lafortune M, Martinet JP, Denys A et al. Short-and long-term hemodynamic effects of transjugular intrahepatic portosystemic shunts: a Doppler/manometric correlative study. Am J Roentgenol. 1995;164:997–1002.Google Scholar
  10. 10.
    Hassoun Z, Pomier-Layrargues G. Transjugular intrahepatic portosystemic shunt in the treatment of portal hypertension. J Gastroentcrol Hepatol. 2004;16:1–4.CrossRefGoogle Scholar
  11. 11.
    Groupe d’Étude des Anastomoses Intrahépatiques. Sclerotherapy plus propranolol in the prevention of variceal bleeding: preliminary results of a multicenter randomized trial. Hepatology. 1995;22:299 (abstract).Google Scholar
  12. 12.
    Cabrera J, Maynar M, Granados R et al. Transjugular intrahepatic portosystemic shunt versus sclerotherapy in the elective treatment of variceal hemorrhage. Gastroenterology. 1996;110:832–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Rössle M, Deibert P, Haag K et al. Randomized trial of transjugular intrahepatic portosystemic shunt versus endoscopy plus propranolol in prevention of variceal rebleeding. Lancet. 1997;349:1043–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Sanyal AJ, Freeman AM, Luketic VA et al. Transjugular intrahepatic portosystemic shunts compared with endoscopic sclerotherapy for the prevention of recurrent variceal hemorrhage. A randomized controlled trial. Ann Intern Med. 1997;126:849–57.PubMedGoogle Scholar
  15. 15.
    Sauer P, Theilman L, Stremmel W, Benz C, Richter GM, Stiehl A. Transjugular intrahepatic portosystemic stent shunt versus sclerotherapy + propranolol for variceal rebleeding. Gastroenterology. 1997; 113: 1623–31.PubMedCrossRefGoogle Scholar
  16. 16.
    Jalan R, Forrest HE, Stanley AJ et al. A randomized trial comparing transjugular intrahepatic portosystemic stent-shunt with variceal band ligation in the prevention of rebleeding from oesophageal varices. Hepatology. 1997;26:1115–22.PubMedGoogle Scholar
  17. 17.
    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. Hepatology. 1998;27:48–53.PubMedCrossRefGoogle Scholar
  18. 18.
    Garcia-Villareal L, Martinez-LaGares K, Sierra A et al. Transjugular intrahepatic portosystemic shunt versus endoscopic sclerotherapy for the prevention of variceal rebleeding after recent variceal hemorrhage. Hepatology. 1999;29:27–32.CrossRefGoogle Scholar
  19. 19.
    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. Ann Intern Med. 1997;126: 858–65.PubMedGoogle Scholar
  20. 20.
    Gulberg V, Schepke M, Geigenberger G et al. Transjugular intrahepatic portosystemic shunting is not superior to endoscopic variceal band ligation for prevention of variceal rebleeding in cirrhotic patients: a randomized clinical trial. Scand J Gastroenterol. 2002;37:338–43.PubMedCrossRefGoogle Scholar
  21. 21.
    Escorsell A, Banares R, Garcia-Pagan JC et al. TIPS versus drug therapy in preventing variceal rebleeding in advanced cirrhosis: a randomized controlled trial. Hepatology. 2002;35:385–92.PubMedCrossRefGoogle Scholar
  22. 22.
    Pomier-Layrargues G, Villeneuve JP, Deschenes M et al. Transjugular intrahepatic portosystemic shunt (TIPS) versus endoscopic variceal ligation in the prevention of variceal rebleeding in patients with cirrhosis: a randomised trial. Gut. 2001;48:390–6.PubMedCrossRefGoogle Scholar
  23. 23.
    Papatheodoridis GV, Goulis J, Leandro G, Patch D, Burroughs AK. Transjugular intrahepatic portosystemic shunt compared with endoscopic treatment for prevention of variceal rebleeding: a meta-analysis. Hepatology. 1999;30:612–22.PubMedCrossRefGoogle Scholar
  24. 24.
    Azoulay D, Castaing D, Majno P et al. Salvage transjugular intrahepatic portosystemic shunt for uncontrolled variceal bleeding in patients with decompensated cirrhosis. J Hepatol. 2001;35:590–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Sarin SK, Lahoti D, Saxena SP, Murthi NS, Makwane UK. Prevalence, classification and natural history of gastric varices: a long-term follow-up study in 568 portal hypertensive patients. Hepatology. 1992;16:1343–9.PubMedCrossRefGoogle Scholar
  26. 26.
    Barange K, Peron JM, Imani K et al. Transjugular intrahepatic portosystemic shunt in the treatment of refractory bleeding from ruptured gastric varices. Hepatology. 1999;30:1139–43.PubMedCrossRefGoogle Scholar
  27. 27.
    Spahr L, Dufresne MP, Bui BT et al. Efficacy of TIPS in the prevention of rebleeding from oesophageal and fundal varices. A comparative study. Hepatology. 1995;22:296 (abstract).Google Scholar
  28. 28.
    Shibata D, Brophy DP, Gordon FD, Anastopoulos HT, Sentovich SM, Bleday R. Transjugular intrahepatic portosystemic shunt for treatment of bleeding ectopic varices with portal hypertension. Dis Colon Rectum. 1999;42:1581–5.PubMedCrossRefGoogle Scholar
  29. 29.
    Spahr L, Villeneuve JP, Dufresne MP et al. Gastric antral vascular ectasia in cirrhotic patients: absence of relation with portal hypertension. Gut. 1999;44:739–42.PubMedCrossRefGoogle Scholar
  30. 30.
    Kamath PS, Lacerda M, Ahlquist DA, McKusick MA, Andrews JC, Nagorney DA. Gastric mucosal response to intrahepatic shunting in patients with cirrhosis. Gastroenterology. 2000;118:905–11.PubMedCrossRefGoogle Scholar
  31. 31.
    Arroyo V, Gines P, Gerbes AL et al. Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. Hepatology. 1996;23:164–76.PubMedCrossRefGoogle Scholar
  32. 32.
    Martinet JP, Legault L, Roy L et al. Treatment of refractory ascites using transjugular intrahepatic portosystemic shunt (TIPS): a caution. Dig Dis Sci. 1997;42:161–6.PubMedCrossRefGoogle Scholar
  33. 33.
    Wong F, Sniderman K, Liu P, Allidina Y, Sherman M, Blendis L. Transjugular intrahepatic portosystemic stent shunt: effects on hemodynamics and sodium homeostasis in cirrhosis and refractory ascites. Ann Intern Med. 1995;122:816–22.PubMedGoogle Scholar
  34. 34.
    Lebrec D, GiuiJy N, Hadengue A et al. Transjugular intrahepatic portosystemic shunts: comparison with paracentesis in patients with cirrhosis and refractory ascites: a randomized trial. French group of Clinicians and a Group of Biologists. J Hepatol. 1996;25:135–44.PubMedCrossRefGoogle Scholar
  35. 35.
    Rossle M, Ochs A, Gulberg V et al. A comparison of paracentesis and transjugular intrahepatic portosystemic shunting in patients with ascites. N Engl J Med. 2000;342:1701–7.PubMedCrossRefGoogle Scholar
  36. 36.
    Gines P, Uriz J, Calahorra B et al. Transjugular intrahepatic portosystemic shunting versus paracentesis plus albumin for refractory ascites in cirrhosis. Gastroenterology. 2002; 123:1839–47.PubMedCrossRefGoogle Scholar
  37. 37.
    Sanyal AJ, Genning C, Reddy KR et al. The North American Study for the Treatment of Refractory Ascites. Gastroenterology. 2003;124:634–41.PubMedCrossRefGoogle Scholar
  38. 38.
    Deschenes M, Dufresne MP, Bui B et al. Predictors of clinical response to transjugular intrahepatic portosystemic shunt (TIPS) in cirrhotic patients with refractory ascites. Am J Gastroenterol. 1999;94:1361–5.PubMedCrossRefGoogle Scholar
  39. 39.
    Gordon FD, Anastopoulos HT, Crenshaw W et al. The successful treatment of symptomatic, refractory hepatic hydrothorax with transjugular intrahepatic portosystemic shunt. Hepatology. 1997;25:1366–9.PubMedCrossRefGoogle Scholar
  40. 40.
    Jeffries MA, Kazanijian S, Wilson M, Punch J, Fontana RJ. Transjugular intrahepatic portosystemic shunts and liver transplantation in patients with refractory hepatic hydrothorax. Liver Transplant Surg. 1998;4:416–23.CrossRefGoogle Scholar
  41. 41.
    Perello A, Garcia-Pagan JC, Gilabert R et al. TIPS is a useful long-term derivative therapy for patients with Budd-Chiari syndrome uncontrolled by medical therapy. Hepatology. 2002;35: 132–9.PubMedCrossRefGoogle Scholar
  42. 42.
    Mancuso A, Fung K, Mela M et al. TIPS for acute and chronic Budd-Chiari syndrome: a single-centre experience. J Hepatol. 2003;38:751–4.PubMedCrossRefGoogle Scholar
  43. 43.
    Spahr L, Fenyves D, Nguyen VV et al. Improvement of hepatorenal syndrome by transjugular intrahepatic portosystemic shunt. Am J Gastroenterol. 1995;90:1169–70.PubMedGoogle Scholar
  44. 44.
    Guevara M, Gines P, Bandi JC et al. Transjugular intrahepatic portosystemic shunt in hepatorenal syndrome: effects on renal function and vasoactive systems. Hepatology. 1998;28:416–22.PubMedCrossRefGoogle Scholar
  45. 45.
    Lasch HM, Fried MW, Zacks SL et al. Use of transjugular intrahepatic portosystemic shunt as a bridge to liver transplantation in a patient with severe hepatopulmonary syndrome. Liver Transplant. 2001;7:147–9.CrossRefGoogle Scholar
  46. 46.
    Azoulay D, Buabse F, Damiano I et al. Neoadjuvant transjugular intrahepatic portosystemic shunt: a solution for extra-hepatic abdominal operation in cirrhotic patients with severe portal hypertension. J Am Coli Surg. 2001;193:46–51.CrossRefGoogle Scholar
  47. 47.
    Vinet E, Perreault P, Bouchard L et al. Transjugular intrahepatic portosystemic shunt (TIPS) before surgery in cirrhotic patients: a retrospective comparative study. Gastroenterology. 2003;124:1411 (abstract).CrossRefGoogle Scholar
  48. 48.
    Sanyal AJ, Contos MJ, Yager D, Zhu YN, Willey A, Graham MF. Development of pseu10.1007/978-0-7923-8797-8ntima and stenosis after transjugular intrahepatic portosystemic shunts: characterization of cell phenotype and function. Hepatology. 1998;28:22–32.PubMedCrossRefGoogle Scholar
  49. 49.
    Bureau C, Garcia-Pagan JC, Olal P et al. Improved clinical outcome using polytetratluoroethylene coated stents for TIPS: results of a randomized study. Gastroenterology. 2004; 126:469–75.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2004

Authors and Affiliations

  • Ziad Hassoun
  • Gilles Pomier-Layrargues
    • 1
  1. 1.Liver Unit, Hôpital Saint-LucCentre Hospitalier de l’Université de MontréalMontrealCanada

Personalised recommendations