[Covered transjugular intrahepatic portosystemic shunts]

Abstract

Transjugular intrahepatic portosystemic shunts (TIPS) consist of a connection created by methods of interventionist radiology between the vena porta and the vena cava through the hepatic parenchyma. By markedly decreasing the portal pressure gradient, TIPS are highly effective in controlling the complications of portal hypertension such as bleeding due to esophageal varices and refractory ascites. Nevertheless, with the use of uncovered stents, the probability of shunt dysfunction -with the consequent reappearance of portal hypertension and its complications- is very high. The use of expandable polytetrafluoroethylene (e-PTFE)-covered stents markedly reduces the incidence of dysfunction, thus decreasing the number of clinical recurrences of portal hypertension and the reinterventions required to maintain shunt patency. The greater effectiveness of e-PTFE-covered stents is not accompanied by a higher incidence of complications or hepatic encephalopathy. Therefore, e-PTFE-covered stents should be preferred over uncovered stents in the management of the complications of portal hypertension.