THE TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC STENT-SHUNT - A REVIEW OFTHE LITERATURE AND OWN EXPERIENCES

The transjugular intrahepatic portosystemic stent-shunt (TIPS) techniq ue consists of a transhepatic puncture of the portal vein and stenting of the parenchymal tract between the hepatic and portal veins. Compli cations of both puncture and stenting are observed in approximately 5% of procedures. Most of the complications are without clinical consequ ences and the procedural mortality is very low in experienced hands (1 %). During a 1 year follow up, 35% of patients were seen to develop st enosis and 15% developed occlusion of the stent-shunt. However, in spi te of the considerable incidence of stenosis/occlusion, the rate of va riceal rebleeding is rare when patients are followed up carefully by d uplex sonography, which allows accurate and early detection of shunt i nsufficiency. One of the major long-term clinical problems of TIPS is the induction or worsening of hepatic encephalopathy. Although most pa tients respond to medical treatment, some develop debilitating encepha lopathy or progressive liver failure. In these patients, reduction of shunt flow by the implantation of a reducing stent, or its occlusion w ith a balloon catheter, may be indicated. In conclusion, in spite of m any complications, TIPS is relatively safe and efficient and hepatic e ncephalopathy is manageable in most cases.