Abstract
The trans jugular intrahepatic Porto systemic shunt (TIPS) is no longer viewed as a salvage therapy or a bridge to liver transplantation and is currently indicated for a number of conditions related to portal hypertension with positive results in survival. Moreover, the availability of self-expandable polytetrafluoroethylene (PTFE)-covered endoprostheses has dramatically improved the long-term patency of TIPS. However, since the last updated International guidelines have been published (year 2009) new evidence have come, which have open the field to new indications and solved areas of uncertainty. On this basis, the Italian Association of the Study of the Liver (AISF), the Italian College of Interventional Radiology—Italian Society of Medical Radiology (ICIR-SIRM), and the Italian Society of Anesthesia, Analgesia and Intensive Care (SIAARTI) promoted a Consensus Conference on TIPS. Under the auspices of the three scientific societies, the consensus process started with the review of the literature by a scientific board of experts and ended with a formal consensus meeting in Bergamo on June 4th and 5th, 2015. The final statements presented here were graded according to quality of evidence and strength of recommendations and were approved by an independent jury. By highlighting strengths and weaknesses of current indications to TIPS, the recommendations of AISF-ICIR-SIRM-SIAARTI may represent the starting point for further studies.
Highlights
The extent of dilation can be considered acceptable when the target porto-systemic pressure gradient (PPG) is reached (1a, A) [14] or an adequate clinical response is obtained (4, C) [14,25,31,32]. 1.6b There is not enough evidence to support the use of 10-mm rather than 8-mm nominal diameter PTFE-covered stents aiming to achieve a better control of portal hypertension complications (5, D) [33,34]
Statement 1.17 trans jugular intrahepatic Porto systemic shunt (TIPS) is associated to an increased incidence of severe Hepatic encephalopathy (HE). (1a) the risk factors for HE should be always considered before TIPS placement (A)(Table 1)
Until RCTs are available for TIPS in this setting, results from derivative surgery must be extrapolated to percutaneous shunting as primary prophylaxis [24]
Summary
S. Fagiuoli et al / Digestive and Liver Disease 49 (2017) 121–137 varices, refractory ascites, hepatic hydrothorax, type-2 hepatorenal syndrome, and more recently, Budd–Chiari syndrome and venoocclusive disease. Fagiuoli et al / Digestive and Liver Disease 49 (2017) 121–137 varices, refractory ascites, hepatic hydrothorax, type-2 hepatorenal syndrome, and more recently, Budd–Chiari syndrome and venoocclusive disease Despite these broad applications, many clinical aspects remain controversial. The multispecialistic contribute to patient selection and TIPS management have led the Italian hepatologic community to produce a consensus statements aimed to the reassessment of the technical and clinical aspects
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