title: Transjugular intrahepatic portosystemic stent-shunt: technical factors and new developments.
abstract: The introduction of expandable metal stents in the mid 1980s led to the development of transjugular intrahepatic portosystemic stent-shunt (TIPSS) as we know it today. Short-lived detrimental effects on the hyperdynamic circulation in cirrhosis accompany the acute reduction in portal pressure following TIPSS creation. Caution is needed in patients with cardiac dysfunction or pulmonary hypertension. With increasing expertise and careful patient selection, fatal procedural complications are rare and TIPSS can even be safely used as a bridge to liver transplantation. Shunt insufficiency and hepatic encephalopathy are more common following TIPSS. Currently, however, novel approaches to tackling both these limitations exist. These include the combination of uncovered TIPSS with variceal band ligation, and the introduction of polytetrafluoroethylene covered stents. Despite the lack of controlled studies, covered stents are now widely used and have the potential to drastically reduce shunt insufficiency, the need for long-term shunt surveillance and even hepatic encephalopathy.
authors.affiliation: Department of Hepatology, Royal Infirmary of Edinburgh, Edinburgh, UK. tdrdhir@aol.com
authors.forename: Dhiraj
authors.initials: D
authors.lastname: Tripathi
authors.forename: Doris
authors.initials: D
authors.lastname: Redhead
mesh_terms: D004867:Equipment Design; D004868:Equipment Failure; D006501:Hepatic Encephalopathy / Q000503:physiopathology; D006801:Humans; D006975:Hypertension, Portal / Q000503:physiopathology / Q000601:surgery*; D008102:Liver Circulation; D011138:Polytetrafluoroethylene; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods / Q000639:trends; D015607:Stents
chemical_list: D011138:Polytetrafluoroethylene