Current use of transjugular intrahepatic portosystemic shunts.
The principal indication for transjugular intrahepatic portosystemic shunts (TIPS) continues to be rescue therapy for variceal hemorrhage that cannot be controlled by endoscopic or medical therapy. TIPS provide no survival advantage in prevention of rebleeding or refractory ascites. The indications for TIPS continue to expand, however, especially for Budd-Chiari syndrome and hydrothorax. Other more novel indications include bleeding portal hypertensive gastropathy or ectopic varices, Budd-Chiari syndrome, veno-occlusive disease, hepatorenal syndrome, hepatopulmonary syndrome, hepatocellular carcinoma, and polycystic liver disease. Great strides have been made recently in models to predict mortality and complications following TIPS placement. Graft stents hold promise based on early studies. Finally, complications are common and may be life threatening.
McCashland
Timothy M
TM
Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, PO Box 983285, Omaha, NE 68198-3285, USA. tmccash@surgery.unmc.edu
D004932:Esophageal and Gastric Varices / Q000150:complications / Q000601:surgery; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery; D016558:Hemostasis, Endoscopic; D006801:Humans; D008107:Liver Diseases / Q000601:surgery*; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects