The transjugular intrahepatic portosystemic shunt in the treatment of portal hypertension.
The transjugular intrahepatic portosystemic shunt (TIPS) represents a major advance in the treatment of complications of portal hypertension. It is most commonly used in the management of refractory variceal bleeding, where it can be life-saving. Two other indications have been studied in randomized controlled trials: prevention of variceal rebleeding and refractory cirrhotic ascites. These trials have demonstrated that TIPS is superior to standard therapy but is associated with a higher rate of hepatic encephalopathy and with no improvement in survival. Consequently, TIPS is considered a second-line therapy in these situations. TIPS has also been used successfully in the treatment of hepatic hydrothorax, hepatorenal syndrome, severe portal hypertensive gastropathy, Budd-Chiari syndrome and veno-occlusive disease. Its use in these indications has only been reported in small uncontrolled series. TIPS usefulness is limited by two major problems: shunt dysfunction and hepatic encephalopathy. Shunt dysfunction is frequently responsible for the recurrence of complications of portal hypertension, and requires a surveillance program to monitor shunt patency. The use of polytetrafluoroethylene-covered stents may help prevent this complication.
Hassoun
Ziad
Z
Liver Unit, Hôpital Saint-Luc, Centre Hospitalier de l'Université de Montreal, Montréal, Québéc, Canada.
Pomier-Layrargues
Gilles
G
D001201:Ascites / Q000601:surgery; D006502:Budd-Chiari Syndrome / Q000601:surgery; D004932:Esophageal and Gastric Varices / Q000601:surgery; D006504:Hepatic Veno-Occlusive Disease / Q000601:surgery; D006530:Hepatorenal Syndrome / Q000601:surgery; D006801:Humans; D006876:Hydrothorax / Q000601:surgery; D006975:Hypertension, Portal / Q000601:surgery*; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects / Q000379:methods*