Transjugular Intrahepatic Portosystemic Shunt (TIPS): Current Status and Future Possibilities

Journal Article · Thu Aug 15 00:00:00 EDT 2002 · Cardiovascular and Interventional Radiology

DOI:https://doi.org/10.1007/S00270-002-1912-2· OSTI ID:21083423

Bilbao, Jose Ignacio ^[1]; Quiroga, Jorge; Herrero, Jose Ignacio ^[2]; Benito, Alberto ^[1]

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1. Department of Radiology, Clinica Universitaria, Facultad de Medicina, Universidad de Navarra, Avenida Pio XII no. 36, E-31008 Pamplona (Spain)
2. Department of Internal Medicine-Hepatology, Clinca Universitaria, Universidad de Navarra, Pamplona (Spain)

Since the insertion of the first TIPS in 1989 much has been learned about this therapeutic procedure. It has an established role for the treatment of some complications of portal hypertension: prevention of recurrent variceal bleeding and rescue of patients with acute uncontrollable variceal bleeding. In addition TIPS is useful for Budd-Chiari syndrome, refractory ascites and hepatorenal syndrome, although its specific role in these indications remains to be definitively established. However, the decrease in sinusoidal blood flow induced by TIPS can lead to the patient developing hepatic encephalopathy and liver failure in some cases. Therefore, TIPS should be used with caution in patients with very poor liver function. From a technical point of view, successful placement of TIPS is achieved in more than 98% of cases by experienced groups. At present, evaluation of TIPS dysfunction based on morphology probably leads to an overdiagnosis of this complication since most of these cases are not associated with clinical manifestations (recurrent bleeding or refractory ascites). The major disadvantage of TIPS remains its poor long-term patency requiring a mandatory surveillance program. The indicator for shunt function/malfunction should be the portosystemic pressure gradient, which is best assessed by intravascular measurements. Shunt obstructions may be prevented or reduced by the use of stent-grafts in the future.

• OSTI ID: 21083423
• Journal Information: Cardiovascular and Interventional Radiology, Vol. 25, Issue 4; Other Information: DOI: 10.1007/s00270-002-1912-2; Copyright (c) 2002 Springer-Verlag New York, Inc; Country of input: International Atomic Energy Agency (IAEA); ISSN 0174-1551
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
ASCITES
BLOOD FLOW
BYPASSES
EVALUATION
FAILURES
GRAFTS
HYPERTENSION
LIVER
PATIENTS
PRESSURE GRADIENTS