Transjugular Intrahepatic Portosystemic Shunt (TIPS)

• A needle catheter is passed via a transjugular route into the hepatic vein and wedged there. The needle is then extruded and advanced through the liver parenchyma to the intrahepatic portion of the hepatic vein to create a “bypass” tract
• TIPS should be considered in patients with refractory ascites or recurrent variceal bleeds who may require a transplant
• a peritoneovenous shunt can be considered in patients with refractory ascites who are not candidates for paracenteses, transplant, or TIPS
• Complications from TIPS:
• Acute: TIPS, portal vein, or splenic vein thrombosis can occur in ~10% of patients, generally in the first month after TIPS
• Chronic: Hepatic encephalopathy, hyperbilirubinemia, hemolytic anemia, TIPS stenosis (approx 75% at 6-12 months)

 

(Victoria Kelly MD, 9/24/10)