What are the complications of Transjugular Intrahepatic Portosystemic Shunt (TIPS)?

From the Guidelines

The main complications of Transjugular Intrahepatic Portosystemic Shunt (TIPS) include hepatic encephalopathy, shunt dysfunction, and liver failure.

Complications of TIPS

• Hepatic encephalopathy: This is a condition where the liver is not able to get rid of unwanted toxic chemicals, such as ammonia, which can cause confusion, drowsiness, or even coma 1.
• Shunt dysfunction: This can occur due to stent stenosis or thrombosis, and is more common with bare metal stents than with polytetrafluoroethylene (PTFE)-covered stents 1.
• Liver failure: TIPS can lead to liver failure, particularly in patients with advanced liver disease, as it can divert blood flow away from the liver 1.
• Other complications: These include bleeding, infection, heart failure, kidney failure, fever, damage to blood vessels and bile ducts, and occur in less than 5% of patients 1.

Risk Factors for Complications

• High Model for End Stage Liver Disease (MELD) score: Patients with higher MELD scores are at increased risk of hepatic encephalopathy and liver failure after TIPS 1.
• Presence of gastrorenal shunt (GRS): This can increase the risk of hepatic encephalopathy and shunt dysfunction 1.
• Use of bare metal stents: These stents are more prone to stenosis and thrombosis than PTFE-covered stents, which can increase the risk of shunt dysfunction 1.

From the Research

Complications of Transjugular Intrahepatic Portosystemic Shunt (TIPS)

The complications of TIPS can be significant and may include:

• Hemorrhage 2
• Hepatic encephalopathy 3, 4
• TIPS dysfunction 2
• Liver failure 2
• Heart failure 4

Prevention and Management of Complications

Prevention and management of these complications are crucial to improve patient outcomes. This can be achieved through:

• Careful patient selection using prognostic scores 3
• Assessments of cardiac and renal function prior to TIPS 3
• Use of small diameter TIPS to prevent post-procedural complications 4
• Correct selection of patients to prevent complications that may frustrate the good hemodynamic results and worsen the patient's quality of life or even life expectancy 4

Established Indications and Additional Complications

TIPS is an effective treatment for complications of portal hypertension, including:

• Portal hypertensive bleeding 5, 3, 6, 4
• Refractory ascites 5, 3, 6, 4
• Hepatic hydrothorax 5, 6, 4
• Hepatorenal syndrome 3, 6, 4
• Bleeding from ectopic varices 4
• Vascular disease of the liver 4
• Portal vein thrombosis 4