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International Journal of Hepatology
Volume 2012, Article ID 167868, 12 pages
http://dx.doi.org/10.1155/2012/167868
Review Article

The Transjugular Intrahepatic Portosystemic Shunt in the Treatment of Portal Hypertension: Current Status

1Liver Unit, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada H2X 3J4
2Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada

Received 17 April 2012; Accepted 18 May 2012

Academic Editor: Averell Sherker

Copyright © 2012 Gilles Pomier-Layrargues et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The transjugular intrahepatic portosystemic shunt (TIPS) represents a major advance in the treatment of complications of portal hypertension. Technical improvements and increased experience over the past 24 years led to improved clinical results and a better definition of the indications for TIPS. Randomized clinical trials indicate that the TIPS procedure is not a first-line therapy for variceal bleeding, but can be used when medical treatment fails, both in the acute situation or to prevent variceal rebleeding. The role of TIPS to treat refractory ascites is probably more justified to improve the quality of life rather than to improve survival, except for patients with preserved liver function. It can be helpful for hepatic hydrothorax and can reverse hepatorenal syndrome in selected cases. It is a good treatment for Budd Chiari syndrome uncontrollable by medical treatment. Careful selection of patients is mandatory before TIPS, and clinical followup is essential to detect and treat complications that may result from TIPS stenosis (which can be prevented by using covered stents) and chronic encephalopathy (which may in severe cases justify reduction or occlusion of the shunt). A multidisciplinary approach, including the resources for liver transplantation, is always required to treat these patients.