Abstract
The transjugular intrahepatic portosystemic shunt (TIPS) has become established as a valuable therapy for the management of the complications of portal hypertension. Despite promising results, it is still a relatively new technique under active investigation. The technical success rate for TIPS placement, that is, the frequency with which a functioning shunt can be placed without acute complications, is greater than 95% in the hands of experienced operators. However, some of the initial enthusiasm surrounding the introduction of TIPS has been appropriately tempered by awareness of its longer-term limitation of shunt insufficiency and complications of hepatic encephalopathy and liver failure. The indications for TIPS represent a work in progress and have been formulated through expert consensus at several conferences, including a workshop sponsored by the National Digestive Diseases Advisory Board in 1994. This review focuses on the principles underlying the use of TIPS and the two major indications for its placement: variceal bleeding and refractory ascites in patients with cirrhosis and portal hypertension.
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