title: Transjugular intrahepatic portosystemic shunt for acute variceal gastrointestinal bleeding: Indications, techniques and outcomes.
abstract: Acute variceal bleeding is a life-threatening condition that requires a multidisciplinary approach for effective therapy. The transjugular intrahepatic portosystemic shunt (TIPS) procedure is a minimally invasive image-guided intervention used for secondary prevention of bleeding and as salvage therapy in acute bleeding. Emergency TIPS should be considered early in patients with refractory variceal bleeding once medical treatment and endoscopic sclerotherapy fail, before the clinical condition worsens. Furthermore, admission to specialized centers is mandatory in such a setting and regional protocols are essential to be organized effectively. This procedure involves establishment of a direct pathway between the hepatic veins and the portal veins to decompress the portal venous hypertension that is the source of the patient's bleeding. The procedure is technically challenging, especially in critically ill patients, and has a mortality of 30%-50% in the emergency setting, but has an effectiveness greater than 90% in controlling bleeding from gastro-esophageal varices. This review focuses on the role of TIPS in the setting of variceal bleeding, with emphasis on current indications and techniques for TIPS creation, TIPS clinical outcomes, and the role of adjuvant embolization of varices.
authors.affiliation: Department of vascular, oncologic and interventional radiology, Le2i UMR CNRS 6306, University of Dijon School of Medicine, Bocage Teaching Hospital, 14, rue Paul-Gaffarel, BP 77908, 21079 Dijon cedex, France. Electronic address: romaric.loffroy@chu-dijon.fr.
authors.forename: R
authors.initials: R
authors.lastname: Loffroy
authors.affiliation: Department of vascular, oncologic and interventional radiology, Le2i UMR CNRS 6306, University of Dijon School of Medicine, Bocage Teaching Hospital, 14, rue Paul-Gaffarel, BP 77908, 21079 Dijon cedex, France.
authors.forename: S
authors.initials: S
authors.lastname: Favelier
authors.affiliation: Department of vascular, oncologic and interventional radiology, Le2i UMR CNRS 6306, University of Dijon School of Medicine, Bocage Teaching Hospital, 14, rue Paul-Gaffarel, BP 77908, 21079 Dijon cedex, France.
authors.forename: P
authors.initials: P
authors.lastname: Pottecher
authors.affiliation: Department of vascular, oncologic and interventional radiology, Le2i UMR CNRS 6306, University of Dijon School of Medicine, Bocage Teaching Hospital, 14, rue Paul-Gaffarel, BP 77908, 21079 Dijon cedex, France.
authors.forename: L
authors.initials: L
authors.lastname: Estivalet
authors.affiliation: Department of vascular, oncologic and interventional radiology, Le2i UMR CNRS 6306, University of Dijon School of Medicine, Bocage Teaching Hospital, 14, rue Paul-Gaffarel, BP 77908, 21079 Dijon cedex, France.
authors.forename: P Y
authors.initials: PY
authors.lastname: Genson
authors.affiliation: Department of vascular, oncologic and interventional radiology, Le2i UMR CNRS 6306, University of Dijon School of Medicine, Bocage Teaching Hospital, 14, rue Paul-Gaffarel, BP 77908, 21079 Dijon cedex, France.
authors.forename: S
authors.initials: S
authors.lastname: Gehin
authors.affiliation: Department of vascular, oncologic and interventional radiology, Le2i UMR CNRS 6306, University of Dijon School of Medicine, Bocage Teaching Hospital, 14, rue Paul-Gaffarel, BP 77908, 21079 Dijon cedex, France.
authors.forename: D
authors.initials: D
authors.lastname: Krausé
authors.affiliation: Department of vascular, oncologic and interventional radiology, Le2i UMR CNRS 6306, University of Dijon School of Medicine, Bocage Teaching Hospital, 14, rue Paul-Gaffarel, BP 77908, 21079 Dijon cedex, France.
authors.forename: J-P
authors.initials: JP
authors.lastname: Cercueil
mesh_terms: D000208:Acute Disease; D004621:Embolization, Therapeutic / Q000379:methods; D004632:Emergency Medical Services / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000401:mortality / Q000628:therapy*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods*; D019233:Retreatment; D015911:Sclerotherapy; D016019:Survival Analysis; D017211:Treatment Failure; D016896:Treatment Outcome
keywords: Cirrhosis; Embolization; Portal hypertension; Transjugular intrahepatic portosystemic shunt; Variceal bleeding