Transjugular intrahepatic portosystemic shunt
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A transjugular intrahepatic portosystemic shunt (TIPS) is a treatment for portal hypertension in which a direct communication is formed between a hepatic vein and a branch of the portal vein, thus bypassing the liver. A successful endpoint is a portosystemic gradient of less than 12 mm of Hg12mmHg.
Indications
Many patients have end stage liver disease. Indications include
- variceal bleeding (preventative in recurrent cases)
- variceal bleeding (for treatment in acute setting5)
- refractory ascites, hepatic hydrothorax
- portal hypertensive gastropathy
- hepatorenal syndrome
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Lower GIlower gastrointestinal and stomal varices -
Malignantmalignant compression of hepatic or portal veins -
Portalportal vein occlusion
Relative contraindications
- Budd-Chiari syndrome
- polycystic kidney disease
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Hypervascularhypervascular hepatictumortumour
Contraindications
- right heart failure
- cavernous transformation of the portal vein
- hepatic failure
Complications
- blockage - TIPS occlusion. A portovenogram with re-stenting is indicated when there is recurrent bleeding and decreased doppler flow on follow up.
- uncontrollable hepatic encephalopathy
- hepatic venous stenosis
- haemorrhage (haemoperitoneum, intrahepatic haematoma, subcapsular haematoma
- sepsis secondary to infection 6
- unintentional arterial access 7,8
Methods to assess patency
- colour Doppler1
- CT angiography 4
- portography with portal manometry
Factors affecting poor survival 5
- hyponatremia
- hyperbilirubinemia
- elevated serum ALT
- advanced liver disease
- coexisting renal insufficiency
See also
-<p>A <strong>transjugular intrahepatic portosystemic shunt (TIPS)</strong> is a treatment for <a href="/articles/portal-hypertension">portal hypertension</a> in which a direct communication is formed between a hepatic vein and a branch of the <a href="/articles/portal-vein">portal vein</a>, thus bypassing the <a href="/articles/couinaud-classification">liver</a>. A successful endpoint is a portosystemic gradient of less than 12 mm of Hg. </p><h5>Indications</h5><p>Many patients have end stage liver disease. Indications include</p><ul>- +<p>A <strong>transjugular intrahepatic portosystemic shunt (TIPS)</strong> is a treatment for <a href="/articles/portal-hypertension">portal hypertension</a> in which a direct communication is formed between a hepatic vein and a branch of the <a href="/articles/portal-vein">portal vein</a>, thus bypassing the <a href="/articles/couinaud-classification">liver</a>. A successful endpoint is a portosystemic gradient of less than 12mmHg. </p><h5>Indications</h5><p>Many patients have end stage liver disease. Indications include</p><ul>
-<li>Lower GI and stomal varices</li>-<li>Malignant compression of hepatic or portal veins</li>-<li>Portal vein occlusion</li>- +<li>lower gastrointestinal and stomal varices</li>
- +<li>malignant compression of hepatic or portal veins</li>
- +<li>portal vein occlusion</li>
-<li><a title="Budd-Chiari syndrome" href="/articles/budd-chiari-syndrome-1">Budd-Chiari syndrome</a></li>-<li><a title="Autosomal recessive polycystic kidney disease" href="articles/polycystic-liver-disease">Polycystic kidney disease</a></li>-<li>Hypervascular hepatic tumor</li>- +<li><a href="/articles/budd-chiari-syndrome-1">Budd-Chiari syndrome</a></li>
- +<li><a href="articles/polycystic-liver-disease">polycystic kidney disease</a></li>
- +<li>hypervascular hepatic tumour</li>
-</ul><p><strong style="font-size:1.2em; font-weight:bold; line-height:0.8em">Complications</strong></p><ul>- +</ul><p><strong>Complications</strong></p><ul>
-</ul><h5>See also</h5><ul><li><a href="/articles/liver-and-biliary-interventional-procedures">Liver and billiary interventional procedures</a></li></ul>- +</ul><h4>See also</h4><ul><li><a href="/articles/liver-and-biliary-interventional-procedures">liver and billiary interventional procedures</a></li></ul>
References changed:
- 7. Kerlan RK, LaBerge JM, Gordon RL et-al. Inadvertent catheterization of the hepatic artery during placement of transjugular intrahepatic portosystemic shunts. Radiology. 1994;193 (1): 273-6. <a href="http://dx.doi.org/10.1148/radiology.193.1.8090907">doi:10.1148/radiology.193.1.8090907</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/8090907">Pubmed citation</a><span class="auto"></span>
- 8. Pattynama PM, van Hoek B, Kool LJ. Inadvertent arteriovenous stenting during transjugular intrahepatic portosystemic shunt procedure and the importance of hepatic artery perfusion. Cardiovasc Intervent Radiol. 1995;18 (3): 192-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7648598">Pubmed citation</a><span class="auto"></span>
- Kerlan RK, LaBerge JM, Gordon RL et-al. Inadvertent catheterization of the hepatic artery during placement of transjugular intrahepatic portosystemic shunts. Radiology. 1994;193 (1): 273-6. <a href="http://dx.doi.org/10.1148/radiology.193.1.8090907">doi:10.1148/radiology.193.1.8090907</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/8090907">Pubmed citation</a><span class="auto"></span>
- Pattynama PM, van Hoek B, Kool LJ. Inadvertent arteriovenous stenting during transjugular intrahepatic portosystemic shunt procedure and the importance of hepatic artery perfusion. Cardiovasc Intervent Radiol. 1995;18 (3): 192-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7648598">Pubmed citation</a><span class="auto"></span>
Images Changes:
Image 1 X-ray (Zoomed image) ( update )
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Case 1 -: TIPS device
Image 2 DSA (angiography) (Stent placed and opened with the aid of a balloon. ) ( update )
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Case 2 -: outlining procedure
Image 3 Annotated image (Coronal) ( update )
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Case 3 -: wedge portal venogram
Image 4 Ultrasound ( update )
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Case 4 -: TIPS occlusion
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