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Transjugular intrahepatic portosystemic shunts: Complications

Authors
Arun J Sanyal, MD
Jasmohan S Bajaj, MD
Section Editor
Sanjiv Chopra, MD, MACP
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF

INTRODUCTION

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.

The direct procedure-related mortality ranges from 0 to 2 percent [1], and the 30-day mortality ranges from 7 to 45 percent, depending on the indication [1-3].

There are three broad categories of complications associated with TIPS insertion:

Technical complications

              

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Literature review current through: Nov 2016. | This topic last updated: Mon Oct 05 00:00:00 GMT+00:00 2015.
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