From the Guidelines
The TIPSS procedure should be performed under the guidance of a specialist, such as an interventional radiologist or hepatologist, with careful patient selection and preparation to minimize complications, as outlined in the British Society of Gastroenterology (BSG) endorsed guidelines 1. When considering the TIPSS procedure, it is essential to weigh the potential benefits against the risks, which include bleeding, infection, heart failure, liver failure, kidney failure, fever, damage to blood vessels and bile ducts, and long-term complications such as hepatic encephalopathy (HE) 1. The main indications for performing a TIPSS are to treat bleeding from swollen veins in the gullet called varices and excessive fluid build-up in the abdomen or stomach known as ascites, with other rarer indications involving diseases affecting the blood vessels leading out of or into the liver 1. To minimize the risk of complications, the following preparation is recommended:
- Specialised scans to look at the liver and surrounding vessels 1
- Patient education on potential complications, including HE, which affects one-third of patients and can be managed with simple measures and medical therapy in most cases 1. The procedure itself typically takes approximately 90–120 min in uncomplicated cases and is performed under general anaesthetic or deep sedation 1. It is crucial to note that the TIPSS procedure is a non-surgical treatment for patients with liver disease and portal hypertension, and its success relies heavily on proper patient selection, preparation, and post-procedure care, as emphasized in the guidelines endorsed by the BSG, BASL, and BSIR 1.
From the Research
TIPS Procedure Overview
- The Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedure is used to treat complications of portal hypertension, including acute variceal bleeding and refractory ascites 2.
- TIPS is also used to prevent variceal rebleeding when pharmacologic and endoscopic therapies have failed 2.
- The procedure involves the creation of a shunt between the portal and hepatic veins to reduce portal pressure 3.
Indications for TIPS
- Refractory ascites with adequate hepatic reserve and renal function 2.
- Budd-Chiari syndrome uncontrolled by medical therapy 2.
- Severe portal hypertensive gastropathy 2.
- Refractory hepatic hydrothorax 2.
- Hepatorenal syndrome 2.
- Early utilization in the treatment of esophageal variceal hemorrhage 4.
- Ectopic varices 4.
- Portal vein thrombosis 4.
Contraindications and Complications
- Recurrent hepatic encephalopathy 5.
- Severe liver dysfunction 5.
- Right heart failure and/or pulmonary hypertension 5.
- Abnormal and/or distorted anatomy 5.
- Shunt dysfunction and hepatic encephalopathy are major limiting factors for TIPS success 2.
- Acute kidney injury (AKI) is a potential complication of TIPS, particularly in patients with impaired renal function at baseline 6.
Procedure-Related Factors
- The type of stent used (bare or covered) can affect the risk of re-intervention due to stent dysfunction 3.
- The interventionalist's experience (number of performed TIPS implantations per year) can also impact the risk of re-intervention 3.
- Proper placement of the stent is crucial to avoid increasing the technical difficulty of the transplantation procedure 2.