Transjugular Intrahepatic Portosystemic Shunt (TIPS)
This section provides a comprehensive procedural report for transjugular intrahepatic portosystemic shunt (TIPS) procedure with up-to-date explanatory notes, synopsis of the indications and contraindications, and potential complications in an organized an
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Bedros Taslakian
Abbreviations
TIPS MELD CBC CMP INR
Transjugular intrahepatic portosystemic shunt Model of end-stage liver disease Complete blood count Complete metabolic profile International Normalized Ratio
INTRODUCTION Transjugular intrahepatic portosystemic shunt (TIPS) is an effective percutaneous image-guided method of reducing portal vein pressure by creating a decompressive channel between a hepatic vein and an intrahepatic branch of the portal vein. It has proven benefit in the treatment of patients who have complications of portal hypertension such as acute and chronic esophageal, gastric, intestinal, and stomal variceal bleeding; severe or refractory ascites; and hepatic hydrothorax; as well as Budd–Chiari syndrome in selected cases. However, TIPS is not a replacement for endoscopic therapy or surgery. The major disadvantages of the TIPS procedure are deterioration of hepatic function caused by diversion of portal venous blood flow and shunt dysfunction,
B. Taslakian (&) Department of Radiology, New York University Langone Medical Center, 660 First Ave, New York, NY 10016, USA e-mail: [email protected]
requiring routine imaging surveillance and shunt maintenance procedures.
COMMON INDICATIONS [1–5] • Secondary prevention of recurrent variceal bleeding in high-risk patients (Level of evidence: 1A) • Refractory ascites defined as ascites that cannot be mobilized or early recurrence of ascites that cannot be adequately prevented by medical therapy (Level of evidence: 1A) • Refractory or uncontrollable acute variceal bleeding (Level of evidence: 1B) • Portal hypertensive gastropathy (Level of evidence: 2B) • Hepatorenal syndromes (types 1 and 2) (Level of evidence: 2B) • Budd–Chiari syndrome with refractory ascites, liver failure, and upper gastrointestinal bleeding (Level of evidence: 4) • Hepatic hydrothorax: significant pleural effusion (>500 mL) in a patient with cirrhosis but
© Springer International Publishing Switzerland 2016 B. Taslakian et al. (eds.), Procedural Dictations in Image-Guided Intervention, DOI 10.1007/978-3-319-40845-3_111
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no primary cardiopulmonary disease (Level of evidence: 4) • Hepatic venoocclusive disease (Level of evidence: 4) • Hepatopulmonary syndrome (Level of evidence: 4) • Decompression of portosystemic collaterals prior to abdominal surgeries Levels of evidence: 1A = systematic review of randomized controlled trials, 1B = individual randomized control trial, 2B = individual cohort study, and 4 = case series.
COMMON CONTRAINDICATIONS [1–5] Absolute contraindications: • Unproved portal hypertension • Severe pulmonary arterial hypertension (mean pulmonary artery pressure > 45 mmHg) • Congestive heart failure • Severe tricuspid regurgitation Relative contraindications (conditions likely to increase the rates of procedural or TIPS-related complications): • APACHE II score, especially in Child C patients (significant post-procedure mortality) • Irreversible phase of hemorrhagic shock • Child-Pugh score > 12 (significant post-procedure mortality) • Model o
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