title: Evolving Indications for Tips.
abstract: Transjugular intrahepatic portosystemic shunt creation is a well-established therapy for refractory variceal bleeding and refractory ascites in patients who do not tolerate repeated large volume paracentesis. Experience and technical improvements including covered stents have led to improved TIPS outcomes that have encouraged an expanded application. Evidence for other less frequent indications continues to accumulate, including the indications of primary prophylaxis in patients with high-risk acute variceal bleeding, gastric and ectopic variceal bleeding, primary treatment of medically refractory ascites, recurrent refractory ascites following liver transplantation, hepatic hydrothorax, hepatorenal syndrome, Budd-Chiari syndrome, and portal vein thrombosis. Treatment of patients with high-risk acute variceal bleeding with early TIPS and using transjugular intrahepatic portosystemic shunts as a primary therapy rather than large volume paracentesis for refractory ascites would likely be the 2 circumstances that permit expansion in the frequency of TIPS procedures. The remaining populations discussed above are relatively rare.
authors.affiliation: Division of Interventional Radiology, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Smith
authors.affiliation: Division of Interventional Radiology, University of Colorado School of Medicine, Aurora, CO. Electronic address: janette.durham@ucdenver.edu.
authors.forename: Janette
authors.initials: J
authors.lastname: Durham
mesh_terms: D001201:Ascites / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000209:etiology; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis; D016031:Liver Transplantation / Q000009:adverse effects; D018579:Patient Selection; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects; D011183:Postoperative Complications / Q000209:etiology; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: TIPS indications; cirrhotic ascites; high-risk variceal bleeding; portal hypertension complications