indications:

• Variceal hemorrhage

• Refractory ascites

• Hepatic hydrothorax

• Severe complications of portal HTN: HRS, portal HTN gastropathy where other treatments have failed.

• Prevention of Rebleeding

Pre-TIPS work-up:

• Cross-sectional imaging for anatomical mapping.

• Echocardiogram to assess presence and severity of systolic and diastolic dysfunction and pulmonary hypertension.

• Correction of coagulopathy based on AASLD guidance

Absolute:

• CHF (EF<50%)

• Severe Pulmonary Arterial Hypertension (MPAP>45mmhg)

• Severe Hepatic Encephalopathy

• Systemic Infection

  Complications:

• Procedural: Intraperitoneal bleeding, arterial injury, sepsis.

• Long-term:

• Hepatic encephalopathy (30% and 50% of at least one episode of HE, 8% probability of severe disabling HE)

• Liver function deterioration(procedure itself induces slight increase of Bilirubin and INR)

• cardiac:

  • Decompensation: 20% (but 50% of those had pre-existing cardiomyopathy) [1]

  • mortality : 5% within 1 year [1]

  • New onset pulmonary hypertension: 4% [2]

Reference:

[1]: A prospective study identifying predictive factors of cardiac decompensation after transjugular intrahepatic portosystemic shunt: the toulouse algorithm

[2]: Cardiac volume overload and pulmonary hypertension in long‐term follow‐up of patients with a transjugular intrahepatic portosystemic shunt

[3]: Lee, Edward Wolfgang1; Eghtesad, Bijan2; Garcia-Tsao, Guadalupe3,4; Haskal, Ziv J.5; Hernandez-Gea, Virginia6; Jalaeian, Hamed7; Kalva, Sanjeeva P.8; Mohanty, Arpan9; Thabut, Dominique10; Abraldes, Juan G.11. AASLD Practice Guidance on the use of TIPS, variceal embolization, and retrograde transvenous obliteration in the management of variceal hemorrhage. Hepatology 79(1):p 224-250, January 2024. | DOI: 10.1097/HEP.0000000000000530