From the Guidelines
Contraindications for TIPS procedure include severe pulmonary hypertension, heart failure, untreated valvular disease, and severe pulmonary arterial hypertension, as these conditions can lead to poor outcomes and increased morbidity and mortality. When considering TIPS, it is essential to evaluate the patient's cardiac function and pulmonary pressures to determine the risk of complications. The following conditions are considered contraindications for TIPS:
- Severe right or left heart dysfunction
- Untreated valvular disease
- Severe pulmonary arterial hypertension (mPAP≥45 mmHg) 1
- American College of Cardiology (ACC)/American Heart Association (AHA) Stage C or D heart failure (HF) 1
- Moderate-severe pulmonary hypertension 1
- Uncontrolled systemic infection 1
- Refractory overt hepatic encephalopathy (HE) 1
- Anatomic barriers to shunt creation, such as multiple hepatic lesions 1
- Significant pulmonary hypertension, heart failure or severe cardiac valvular insufficiency, rapidly progressive liver failure, severe or uncontrolled hepatic encephalopathy, uncontrolled systemic infection or sepsis, unrelieved biliary obstruction, polycystic liver disease, and extensive primary or metastatic hepatic malignancy 1 It is crucial to carefully assess each patient's individual condition and consider the potential risks and benefits of the TIPS procedure to ensure the best possible outcome in terms of morbidity, mortality, and quality of life.
From the Research
Contraindications for TIPS Procedure
The contraindications for the Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedure include:
- Severe liver dysfunction 2, 3, 4
- Recurrent hepatic encephalopathy without an identifiable precipitating factor 2, 3, 4
- Right heart failure 2, 3
- Pulmonary hypertension 2, 3, 4
- Severe uncontrolled hepatic encephalopathy 4
- Systemic infection or sepsis 4
- Congestive heart failure 4
- Biliary obstruction 4
- Very advanced disease (Child-Pugh >13 points) 3
Additional Considerations
Abnormal and/or distorted anatomy can also make the TIPS procedure unfeasible 2. In such cases, alternative procedures like Direct Intrahepatic Portocaval Shunt (DIPS) or Transjugular Transcaval Intrahepatic Portosystemic Shunt (TTIPS) may be considered 2.