THE FIRST DECADE OF THE TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT(TIPS) - STATE-OF-THE-ART

The transjugular intrahepatic portosystemic shunt (TIPS) is an interve ntional treatment resulting in decompression of the portal system by c reation of a side-to-side portosystemic anastomosis. Since its introdu ction 10 years ago, more than 500 publications have appeared demonstra ting rapid acceptance and increasing clinical use. This review summari zes the present knowledge of technical aspects and complications, foll ow-up of patients, and indications. With respect to the technique, the TIPS procedure is probably one of the most difficult interventions an d, therefore, technical success and complications clearly depend on th e skills of the operator. Thus, the number and kind of complications r eported in this review do not necessarily relate to the procedural com plications of an experienced center. The follow-up of the TIPS patient has to assess shunt patency, Liver function and hepatic encephalopath y. Shunt patency can best be monitored by duplex-sonography. Routine r adiological revision seems not to be helpful and does not improve resu lts, i.e., rebleeding and survival. Short term patency may be improved by anticoagulation, while such a treatment does not influence long-te rm patency. With respect to the indications of TIPS, much is known abo ut treatment of variceal bleeding. The nine randomized studies that ar e available to date show that survival is comparable between patients receiving TIPS or endoscopic treatment. The second group of patients i s the group with refractory ascites and related complications, such as hepatorenal syndrome and hepatic hydrothorax. It has been demonstrate d that TIPS improves these complications, but randomized studies are s till lacking. In addition, TIPS has been applied successfully to patie nts with Budd-Chiari syndrome, portal vein thrombosis, before liver tr ansplantation, and for the treatment of ectopic portal hypertensive bl eeding.