Is a spontaneous portosystemic shunt (SPSS) the same as a transjugular intra‑hepatic portosystemic shunt (TIPS)?

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Last updated: September 21, 2026 • View editorial policy

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No, SPSS and TIPS are fundamentally different entities

A spontaneous portosystemic shunt (SPSS) is a naturally occurring collateral vessel that develops in cirrhosis, while a transjugular intrahepatic portosystemic shunt (TIPS) is an artificially created stent-shunt placed via interventional radiology. These are completely distinct anatomical and clinical entities, though they can interact in important ways.

Key Differences

SPSS (Spontaneous Portosystemic Shunt)

  • Naturally occurring collateral vessels that develop as a consequence of portal hypertension in cirrhotic patients
  • Form spontaneously as the body attempts to decompress the portal system
  • Most commonly gastro-renal shunts (78.89% of cases) 1
  • Present in over 60% of cirrhotic patients on contrast-enhanced CT 2
  • Represent radiological biomarkers of clinically significant portal hypertension 2

TIPS (Transjugular Intrahepatic Portosystemic Shunt)

  • Artificially created by interventional radiologists
  • Involves placing a metal stent inside the liver via the jugular vein in the neck 3
  • Performed under general anesthesia or deep sedation, taking 90-120 minutes 3
  • Created specifically to treat complications of portal hypertension (variceal bleeding, refractory ascites) 3

Clinical Interaction Between SPSS and TIPS

The relationship between these two entities is clinically significant:

SPSS Behavior After TIPS Creation

When TIPS is placed, SPSS area typically decreases significantly (median reduction from 67.2 to 15.7 mm², p<0.001), while total shunt area (TIPS + SPSS) remains unchanged 4. The relative decrease in SPSS area after TIPS is an independent protective factor for mortality (HR: 0.19, p=0.034) 4.

Management Considerations

For large SPSS (>6mm) at time of TIPS placement:

  • Embolization of SPSS may be considered during elective TIPS for ascites/hepatic hydrothorax to reduce post-TIPS hepatic encephalopathy risk 5
  • TIPS combined with concurrent SPSS embolization in patients with large SPSS achieves better 2-year transplant-free survival (84.38% vs 71.28%, p=0.045) and lower hepatic encephalopathy rates (29.69% vs 53.33%, p=0.001) compared to TIPS alone 6

For refractory hepatic encephalopathy from large SPSS:

  • In select patients with large SPSS (>6mm) and refractory hepatic encephalopathy, shunt embolization should be considered 5
  • SPSS embolization achieves 83.1% hepatic encephalopathy remission rate with 99.8% procedural success 7
  • If portal hypertensive complications develop after SPSS embolization, small caliber TIPS creation can be considered 5

Clinical Significance of SPSS Size

Larger SPSS diameter correlates with:

  • Higher MELD scores, INR, and total bilirubin 1
  • Lower rebleeding risk (3.38% in large SPSS vs 14.64-16.88% in smaller SPSS, representing 77% reduction in rebleeding risk) 1
  • Worse baseline liver function but paradoxically better bleeding outcomes 1

Common Pitfall

Do not confuse these entities or use the terms interchangeably. SPSS represents the body's natural response to portal hypertension, while TIPS is a therapeutic intervention. However, recognize that they interact clinically—large SPSS may need to be addressed (embolized) at the time of TIPS placement to optimize outcomes, particularly for hepatic encephalopathy prevention.

References

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.