Role of Transjugular Intrahepatic Portosystemic Shunt in the Management of Portal Hypertension: Review and Update of the Literature

Matthew L Hung; Edward Wolfgang Lee

doi:10.1016/j.cld.2019.07.004

Role of Transjugular Intrahepatic Portosystemic Shunt in the Management of Portal Hypertension: Review and Update of the Literature

Clin Liver Dis. 2019 Nov;23(4):737-754. doi: 10.1016/j.cld.2019.07.004. Epub 2019 Aug 31.

Authors

Matthew L Hung¹, Edward Wolfgang Lee²

Affiliations

¹ Division of Interventional Radiology, Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Ronald Reagan Medical Center at UCLA, 757 Westwood Plaza, Suite 2125, Los Angeles, CA 90095, USA.
² Division of Interventional Radiology, Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Ronald Reagan Medical Center at UCLA, 757 Westwood Plaza, Suite 2125, Los Angeles, CA 90095, USA; Department of Surgery, Division of Liver and Pancreas Transplant Surgery, Ronald Reagan Medical Center at UCLA, 757 Westwood Plaza, Los Angeles, CA 90095, USA. Electronic address: edwardlee@mednet.ucla.edu.

PMID: 31563220
DOI: 10.1016/j.cld.2019.07.004

Abstract

Transjugular intrahepatic portosystemic shunt (TIPS) is a well-established procedure used in the management of complications of portal hypertension. Although the most robust evidence supports the use of TIPS as salvage therapy in variceal hemorrhage, secondary prophylaxis of variceal bleeding, and treatment of refractory ascites, there is also data to suggest its efficacy in other indications such as hepatic hydrothorax, hepatorenal syndrome, and Budd-Chiari syndrome. Recent literature also suggests that TIPS may improve survival for certain subpopulations if placed early after variceal bleeding. This article provides an updated evidence-based review of the indications for TIPS. Outcomes, complications, and adequate patient selection are also discussed.

Keywords: Ascites; Esophageal varices; Portal hypertension; TIPS; Transjugular intrahepatic portosystemic shunt.

Publication types

Review

MeSH terms

Ascites / etiology
Ascites / therapy*
Budd-Chiari Syndrome / etiology
Budd-Chiari Syndrome / therapy
Esophageal and Gastric Varices / etiology
Esophageal and Gastric Varices / therapy*
Gastrointestinal Hemorrhage / etiology
Gastrointestinal Hemorrhage / prevention & control*
Gastrointestinal Hemorrhage / therapy
Hepatorenal Syndrome / etiology
Hepatorenal Syndrome / therapy
Humans
Hydrothorax / etiology
Hydrothorax / therapy
Hypertension, Portal / complications
Hypertension, Portal / therapy*
Patient Selection
Portasystemic Shunt, Transjugular Intrahepatic / methods*
Primary Prevention
Salvage Therapy
Secondary Prevention
Survival Rate