From the Guidelines
The procedure for a Transjugular Intrahepatic Portosystemic Shunt (TIPS) involves the placement of a PTFE-covered stent between the portal and hepatic veins to reduce portal pressure.
Key Steps in the TIPS Procedure
- The procedure is typically performed under general anaesthetic or deep sedation and takes approximately 90-120 minutes in uncomplicated cases 1.
- A wire is inserted through the jugular vein in the neck and guided through the liver using X-ray to place the stent 1.
- The portal pressure gradient should be measured pre- and post-stent deployment, with a goal of reducing the gradient to <12 mmHg or by >=20% of baseline in cases of variceal bleeding 1.
- PTFE-covered stents are recommended due to their association with better patency rates than bare stents 1.
Indications for TIPS
- Acute variceal bleeding unresponsive to other treatments 1.
- Prevention of further re-bleeding from varices in patients who have bled again despite standard of care endoscopic and medical therapies 1.
- Treatment of recurrent ascites or hydrothorax despite other treatments 1.
- Treatment of Budd-Chiari syndrome in specialist hospitals that also offer liver transplantation 1.
Post-Procedure Care
- Doppler ultrasound is recommended a week after TIPS implantation in patients with prothrombotic conditions, and in other patients where TIPS dysfunction is suspected 1.
- Regular follow-up with Doppler ultrasound is recommended to monitor for TIPS dysfunction and hepatic encephalopathy 1.
From the Research
Procedure Overview
The Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedure is used to treat complications of portal hypertension in patients with liver disease. The procedure involves creating a shunt between the portal vein and the hepatic vein to reduce portal pressure.
Indications for TIPS
- Recurrent or refractory variceal bleeding 2
- Refractory ascites 2, 3
- Acute variceal bleed 2
- Hepatic hydrothorax 2
- Hepatorenal syndrome 2, 3
- Portal vein thrombosis 4
- Recurrent liver disease 4
- Hepatic venous outflow obstruction (HVOO) 4
Procedure Techniques
- TIPS creation using polytetrafluoroethylene-covered stents 2
- TIPS reduction and occlusion techniques to mitigate overshunting 5
- Direct intrahepatic portocaval shunt (DIPS) or transjugular transcaval intrahepatic portosystemic shunt (TTIPS) as alternative procedures in cases of unfavorable anatomy 6
Patient Selection and Outcomes
- Patient selection using prognostic scores can lead to excellent outcomes 3
- Assessments of cardiac and renal function prior to TIPS may improve patient prognosis 3
- TIPS placement can serve as a bridge to liver transplantation in properly selected candidates 4
- TIPS in liver transplant recipients are associated with a lower clinical response rate and a higher rate of complications compared to patients with native liver disease 4