From the Guidelines
The five indications for Transjugular Intrahepatic Portosystemic Shunt (TIPS) include refractory ascites, variceal bleeding, hepatic hydrothorax, Budd-Chiari syndrome, and hepatorenal syndrome, as supported by the most recent guidelines 1.
Indications for TIPS
- Refractory ascites: TIPS is primarily used when a patient has refractory ascites that doesn't respond to diuretic therapy and repeated paracentesis, creating a shunt that reduces portal pressure and fluid accumulation.
- Variceal bleeding: TIPS is indicated when endoscopic and pharmacological treatments fail to control bleeding from esophageal or gastric varices, with a technical success rate of over 90% 1.
- Hepatic hydrothorax: characterized by pleural effusion in cirrhotic patients, may require TIPS when chest tube drainage and diuretics are ineffective.
- Budd-Chiari syndrome: TIPS can decompress the liver and improve symptoms when anticoagulation therapy is insufficient.
- Hepatorenal syndrome: TIPS may be considered in select cases to improve renal perfusion by reducing portal hypertension, though this indication is less established than the others.
Procedure and Risks
The procedure works by creating a channel between the portal and hepatic veins, effectively bypassing the liver and reducing portal pressure, though it carries risks including hepatic encephalopathy and potential shunt dysfunction 1.
Patient Selection
Patient selection is crucial, and factors such as bilirubin levels, platelet count, and pre-existing encephalopathy should be considered when deciding on TIPS insertion 1.
Recent Guidelines
Recent guidelines emphasize the importance of discussing TIPS insertion with the regional transplant centre in patients eligible for liver transplantation 1, and considering TIPS for patients with refractory ascites who require frequent paracentesis 1.
From the Research
TIPS Indications
The following are indications for Transjugular Intrahepatic Portosystemic Shunt (TIPS) placement:
- Refractory ascites: TIPS is used to treat ascites that is unresponsive to other treatments, such as large volume paracentesis 2, 3, 4, 5, 6
- Acute variceal bleeding: TIPS is used to treat bleeding from esophageal or gastroesophageal varices that is unresponsive to pharmacological and endoscopic therapy 2, 3, 4, 5, 6
- Prevention of recurrent variceal hemorrhage: TIPS is used to prevent rebleeding in patients who have had a previous variceal bleed 2, 3, 4, 5, 6
- Budd-Chiari syndrome: TIPS is used to treat this condition, which is characterized by thrombosis of the hepatic veins 2, 3, 5
- Portal vein thrombosis: TIPS is used to treat this condition, which is characterized by thrombosis of the portal vein 2, 3, 5
- Hepatic hydrothorax: TIPS is used to treat this condition, which is characterized by fluid accumulation in the pleural space due to liver disease 3, 5, 6
- Hepatorenal syndrome: TIPS is used to treat this condition, which is characterized by kidney dysfunction due to liver disease 3, 5, 6
- Gastric and ectopic variceal bleeding: TIPS is used to treat bleeding from varices in the stomach or other locations outside of the esophagus 5
- Primary prophylaxis in patients with high-risk acute variceal bleeding: TIPS is used to prevent bleeding in patients who are at high risk of variceal bleeding 5
- Recurrent refractory ascites following liver transplantation: TIPS is used to treat ascites that recurs after liver transplantation 5
New and Emerging Indications
Some studies suggest that TIPS may also be beneficial in other situations, including: