Transjugular intrahepatic portosystemic shunts (TIPS) - A decade later

Since the introduction of transjugular intrahepatic portosys-temic shunt (T IPS) 10 years ago, it has been used increasingly in the management nf porta l hypertension and its complication TIPS is now considered the procedure of choice for management nf refractory variceal bleeding. Its role in the man agement of refractory ascites, hepatic hydrothorax, hepatorenal syndrome, a nd hepatopulmonary syndrome still awaits further prospective studies. The t wo main complications of TIPS are hepatic encephalopathy and shunt malfunct ion. Generally, TIPS stenosis or occlusion is a major drawback requiring ro utine surveillance of TIPS with doppler ultrasound. Venography with balloon dilation of the stent or placement of serial or parallel stents may be req uired in some cases. Promising modalities of preventing TIPS malfunction (e .g., brachytherapy, covered stents, or anti-platelet derived growth factor) are currently being investigated.