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Review
. 2014 Sep;31(3):235-42.
doi: 10.1055/s-0034-1382790.

Transjugular intrahepatic portosystemic shunt: indications, contraindications, and patient work-up

Alexander Copelan  1 , Baljendra Kapoor  2 , Mark Sands  2
Affiliations
Review

Transjugular intrahepatic portosystemic shunt: indications, contraindications, and patient work-up

Alexander Copelan et al. Semin Intervent Radiol. 2014 Sep.

Abstract

The transjugular intrahepatic portosystemic shunt (TIPS) procedure is effective in achieving portal decompression and in managing some of the major complications of portal hypertension. While many clinicians are familiar with the two most common indications for TIPS placement, secondary prophylaxis of esophageal variceal hemorrhage and treatment of refractory ascites, evidence for its usefulness is growing in other entities, where it has been less extensively studied but demonstrates promising results. Newer indications include early utilization in the treatment of esophageal variceal hemorrhage, Budd-Chiari syndrome, ectopic varices, and portal vein thrombosis. The referring clinician and interventionist must remain cognizant of the contraindications to the procedure to avoid complications and potential harm to the patient. This review is designed to provide an in-depth analysis of the most common as well as less typical indications for TIPS placement, and to discuss the contraindications and appropriate patient evaluation for this procedure.

Keywords: contraindications; indications; interventional radiology; portal hypertension; transjugular intrahepatic portosystemic shunt.

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Figures

Figure 1
Figure 1
Coronal contrast-enhanced computed tomography of the abdomen demonstrates avidly enhancing, markedly tortuous, and dilated varices surrounding the lower esophagus (yellow arrow). There is also significant perihepatic and perisplenic ascites (black arrows). The spleen is enlarged secondary to portal hypertension.
Figure 2
Figure 2
Coronal contrast-enhanced computed tomography demonstrates avidly enhancing tortuous and dilated rectal (hemorrhoidal) varices (arrow).
Figure 3
Figure 3
Axial contrast-enhanced computed tomography image through the abdomen demonstrates enhancing, tortuous dilated varices (arrows) in the region of the gastric fundus.
See this image and copyright information in PMC

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