TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNTS (TIPS)

Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure re cently introduced for the management of complications of portal hypert ension. TIPS can be placed in the liver with relative ease by a skille d radiologist with a low risk of mortality. The major complications fo llowing the procedure are infection, especially in patients undergoing emergency TIPS, intra-abdominal haemorrhage from capsular punctures, and long-term problems related to encephalopathy and stenosis of the s hunt. Encephalopathy is more of a problem in older patients with wide diameter shunts. Stenosis of the shunt is related to pseudo-intimal hy perplasia, probably related to transection of bile ductules during pla cement of the shunt. In view of the high rate of encephalopathy and st enosis following the shunt, a careful follow-up of all patients, inclu ding ultrasonographic and angiographic examination of the shunt, is ma ndatory. TIPS is used predominantly for the control of acute variceal haemorrhage, prevention of recurrent variceal bleeding, and refractory ascites when conventional treatment has failed. However, the role of TIPS in the management of complications of portal hypertension still a waits the outcome of clinical trials.