Portal hypertension (PH) plays an important role in the natural history of
cirrhosis, and is associated with several clinical consequences. The introduction of transjugular intrahepatic
portosystemic shunts (
TIPS) in the 1980s has been regarded as a major technical advance in the management of the PH-related complications. At present,
polytetrafluoroethylene-covered
stents are the preferred option over traditional bare
metal stents.
TIPS is currently indicated as a
salvage therapy in patients with
bleeding esophageal varices who fail standard treatment. Recently, applying
TIPS early (within 72 h after admission) has been shown to be an effective and life-saving treatment in those with high-risk variceal
bleeding. In addition,
TIPS is recommended as the second-line treatment for secondary prophylaxis. For
bleeding gastric varices, applying
TIPS was able to achieve hemostasis in more than 90% of patients. More trials are needed to clarify the efficacy of
TIPS compared with other treatment modalities, including
cyanoacrylate injection and balloon retrograde transvenous obliteration of
gastric varices.
TIPS should also be considered in
bleeding ectopic
varices and refractory portal hypertensive gastropathy. In patients with refractory
ascites, there is growing evidence that
TIPS not only results in better control of
ascites, but also improves long-term survival in appropriately selected candidates. In addition,
TIPS is a promising treatment for refractory hepatic
hydrothorax. However, the role of
TIPS in the treatment of hepatorenal and
hepatopulmonary syndrome is not well defined. The advantage of
TIPS is offset by a risk of developing
hepatic encephalopathy, the most relevant post-procedural complication. Emerging data are addressing the determination the optimal time and patient selection for
TIPS placement aiming at improving long-term treatment outcome. This review is aimed at summarizing the published data regarding the application of
TIPS in the management of complications related to PH.