Transjugular Intrahepatic Portosystemic Shunt

Excerpt

Transjugular intrahepatic portosystemic shunt (TIPS) is now a well established percutaneous means of decreasing portal hypertension. The major clinical indications for transjugular intrahepatic portosystemic shunt are refractory variceal hemorrhage and refractory ascites. The shunt itself is created by placing a stent between the portal vein and the hepatic vein. The resultant shunting of portal venous flow to the systemic circulation helps reduce the portosystemic gradient and alleviate bleeding and ascites without changing the extrahepatic anatomy.

History and Development

The transjugular intrahepatic portosystemic shunt was initially described in 1969, originally by prolonged balloon dilation of a percutaneously created tract between the portal and hepatic veins. Unfortunately, short patency of the track remained a major clinical hurdle to its widespread use. The development of balloon expandable metallic stents and the subsequent introduction of flexible bare-metal stents helped improve patency rates. Intimal hyperplasia within the stent, especially at the hepatic venous end, required frequent secondary interventions such as balloon dilation and re-stenting. Early thrombosis was felt to be secondary to placing the transjugular intrahepatic portosystemic shunt across a major bile duct. Advances in stent technology and the introduction of polytetrafluoroethylene-covered stents over a decade ago has led to further increase in clinical patency and improved long-term results with TIPS.