![]() The indications for TIPS with the most evidence-based support are secondary prophylaxis of esophageal variceal hemorrhage and treatment of refractory ascites. 1 Typically performed by an interventional radiologist under fluoroscopic guidance and general anesthesia, it is advantageous over the surgical portocaval shunt in that it does not subject the patient to a large abdominal incision and potentially decreases the morbidity and length of hospital stay. Originally described by Rösch et al in 1969 as a “radiologic portocaval shunt,” the transjugular intrahepatic portosystemic shunt (TIPS) procedure is a minimally invasive nonsurgical method of achieving portal decompression to treat some of the major complications of portal hypertension. Physicians should claim only the credit commensurate with the extent of their participation in the activity. TUSM is accredited by the ACCME to provide continuing medical education for physicians.Ĭredit: Tufts University School of Medicine designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit TM. Objectives: Upon completion of this article, the reader will be able to describe the indications, contraindications, and patient work-up algorithm for placement of a TIPS.Īccreditation: This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Tufts University School of Medicine (TUSM) and Thieme Medical Publishers, New York. This review is designed to provide an in-depth analysis of the most common as well as less typical indications for TIPS placement, and to discuss the contraindications and appropriate patient evaluation for this procedure. The referring clinician and interventionist must remain cognizant of the contraindications to the procedure to avoid complications and potential harm to the patient. Newer indications include early utilization in the treatment of esophageal variceal hemorrhage, Budd–Chiari syndrome, ectopic varices, and portal vein thrombosis. While many clinicians are familiar with the two most common indications for TIPS placement, secondary prophylaxis of esophageal variceal hemorrhage and treatment of refractory ascites, evidence for its usefulness is growing in other entities, where it has been less extensively studied but demonstrates promising results. The transjugular intrahepatic portosystemic shunt (TIPS) procedure is effective in achieving portal decompression and in managing some of the major complications of portal hypertension. ![]()
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