Transjugular Intrahepatic Portosystemic Shunt: TIPS

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.