Transjugular Intrahepatic Portosystemic Shunt

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Transjugular Intrahepatic Portosystemic Shunt
Supervised by VS ????? Presented by R1 ???
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Introduction
TIPS A procedure Tubular metal device
stent Hepatic vein ? shunt ? Portal vein ?
Portal HTN
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Introduction
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Introduction - EV

• Drugs Therapy Beta-blockers or long-acting
  nitrates
• Other drugs
  Terlipressin, Vasopressin,
• 
  NTG, Octreotide
• 
  Somatostatin.
• Variceal Band Ligation
• Sclerotherapy
• TIPS
• DSRS
• Liver Transplant

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Introduction
Portocaval shunt
Splenorenal shunt
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Introduction
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American Association for the Study of Liver
Diseases
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The Procedure
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The Procedure
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The Procedure

• Purpose of TIPS
• decompress the portal venous system
• prevent rebleeding from varices or stop or reduce
  the formation of ascites.
• Hepatic venous pressure gradient (HVPG)
• can be reduced to less than 12 mm Hg, the risk of
  bleeding will fall significantly.
• but at the cost of an increased incidence of
  encephalopathy.
• for the control of refractory ascites is even
  less clear (less than 8 mm Hg)

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Contraindications
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Indications
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Complications

• Possible complications of the procedure
• allergic reaction of contrast material
• muscle stiffness in the neck
• bruising on the neck at the point of catheter
  insertion
• Puncture site infection
• Serious complications
• occlusion, or complete blockage, of the stent and
  rapid recurrence of symptoms
• infection of the stent
• intra-abdominal bleeding
• heart arrhythmias or congestive heart failure
• hepatic encephalopathy
• hepatic failure

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Complications
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Conclusions

• Once a TIPS is created, frequent monitoring by
  Doppler ultrasound (TIPS dysfunction)
• TIPS effectively
• prevent rebleeding from varices
• decrease the need for repeat thoracentesis in
  pts with hepatic hydrothorax or for large-volume
  paracentesis in pts with refractory ascites.
• But, it increase incidence of hepatic
  encephalopathy and will not improve survival

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Conclusions

• TIPS should not be considered as primary therapy
  for any complication of portal hypertension with
  the exception of bleeding gastric or ectopic
  varices.
• TIPS should only be created when the patient has
  failed other forms of medical therapy (i.e.,
  pharmacological or endoscopic therapy, diuretics,
  or repeated large-volume paracentesis or
  thoracentesis).
• In pts with good liver function and recurrent
  bleeding from varices despite medical treatment,
  it is unclear whether a surgical shunt orTIPS is
  the better form of therapy pending the
  publication of additional controlled trials.
• Budd-Chiari syndrome are best managed by TIPS
  remains undefined, although creation of
• a TIPS in select patients may be of
  benefit.
• Creation of a TIPS for the treatment of
  hepatorenal syndrome or hepatopulmonary syndrome
  is of unproven benefit and should be considered
  investigatory.

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