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01-01-2020 | Hepatic Encephalopathy | IM - REVIEW

Transjugular intrahepatic portosystemic shunt (TIPS): current indications and strategies to improve the outcomes

Authors: Francesco Vizzutti, Filippo Schepis, Umberto Arena, Fabrizio Fanelli, Stefano Gitto, Silvia Aspite, Laura Turco, Gabriele Dragoni, Giacomo Laffi, Fabio Marra

Published in: Internal and Emergency Medicine | Issue 1/2020

Abstract

Transjugular intrahepatic portosystemic shunt (TIPS) represents a very effective treatment of complications of portal hypertension. Established indications to TIPS in cirrhotic patients include portal hypertensive bleeding and refractory ascites. Over the years additional indications have been proposed, such as the treatment of vascular disease of the liver, hepatic hydrothorax, hepatorenal syndrome and bleeding from ectopic varices. Indications under evaluation include treatment of portal hypertension prior to major abdominal surgery and treatment of portal vein thrombosis. In spite of these advances, there are still uncertainties regarding the appropriate workup for patients to be scheduled for TIPS. Moreover, prevention and management of post-TIPS complications including hepatic encephalopathy and heart failure are still suboptimal. These issues are particularly relevant considering aging in TIPS candidates in Western countries. Correct selection of patients is mandatory to prevent complications which may eventually frustrate the good hemodynamic results and worsen the patient’s quality of life or even life expectancy. The possible role of small diameter TIPS to prevent post-procedural complications is discussed.

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Title: Transjugular intrahepatic portosystemic shunt (TIPS): current indications and strategies to improve the outcomes
Authors: Francesco Vizzutti
Filippo Schepis
Umberto Arena
Fabrizio Fanelli
Stefano Gitto
Silvia Aspite
Laura Turco
Gabriele Dragoni
Giacomo Laffi
Fabio Marra
Publication date: 01-01-2020
Publisher: Springer International Publishing
Keywords: Hepatic Encephalopathy
Portal Vein Thrombosis
Hepatorenal Syndrome
Heart Failure
Portal Vein Thrombosis
Ascites
Hepatic Encephalopathy
Hepatorenal Syndrome
Portal Hypertension
Portal Hypertension
Published in: Internal and Emergency Medicine / Issue 1/2020
Print ISSN: 1828-0447
Electronic ISSN: 1970-9366
DOI: https://doi.org/10.1007/s11739-019-02252-8

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