Transjugular intrahepatic portosystemic shunts: Complications
- Arun J Sanyal, MD
Arun J Sanyal, MD
- Professor of Medicine
- Virginia Commonwealth University School of Medicine
- Jasmohan S Bajaj, MD
Jasmohan S Bajaj, MD
- Associate Professor of Medicine
- Virginia Commonwealth University and McGuire VA Medical Center
- Section Editor
- Sanjiv Chopra, MD, MACP
Sanjiv Chopra, MD, MACP
- Editor-in-Chief — Gastroenterology/Hepatology
- Section Editor — General Hepatology; Gallbladder and Biliary Tract Disease
- Professor of Medicine
- Harvard Medical School
- Senior Consultant in Hepatology
- James Tullis Firm Chief
- Beth Israel Deaconess Medical Center
Transjugular intrahepatic portosystemic shunt or stent-shunt (TIPS) insertion is an important addition to the therapeutic armamentarium against portal hypertension; it decompresses the portal vein in a manner analogous to side-to-side surgical portacaval shunts, but avoids the risks of general anesthesia and major surgery. TIPS insertion involves creation of a low-resistance channel between the hepatic vein and the intrahepatic portion of the portal vein (usually the right branch) using angiographic techniques (figure 1 and image 1). The tract is kept patent by deployment of an expandable metal stent across it, thereby allowing blood to return to the systemic circulation. TIPS insertion has been used primarily for control of variceal bleeding, but also appears to be effective in refractory ascites (figure 1). (See "Transjugular intrahepatic portosystemic shunts: Indications and contraindications".)
However, TIPS insertion can be associated with a number of complications, some of which may be fatal. It is therefore essential for all who use this procedure to be cognizant of the clinical spectrum of TIPS-related complications and their management.
There are three broad categories of complications associated with TIPS insertion:
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- TECHNICAL COMPLICATIONS
- Complications related to access to the hepatic vein
- Complications related to creation of the intrahepatic tract
- Complications of portal vein manipulation and stent placement
- COMPLICATIONS RELATED TO PORTOSYSTEMIC SHUNTING
- Portosystemic encephalopathy
- Cardiovascular complications
- UNIQUE TIPS-RELATED COMPLICATIONS
- Hemolytic anemia
- Severe hyperbilirubinemia
- Vegetative infections
- TIPS stenosis
- - Monitoring TIPS patency
- SUMMARY AND RECOMMENDATIONS