Abstract
Since Richter's description in the literature in 1989 of the first procedure on human patients, transjugular intrahepatic portosystemic shunt (TIPS) has been worldwide considered as a noninvasive technique to manage portal hypertension complications. TIPS succeeds in lowering the hepatic sinusoidal pressure and in increasing the circulatory flow, thus reducing sodium retention, ascites recurrence, and variceal bleeding. Required several revisions of the shunt TIPS can be performed in case of different conditions such as hepatorenal syndrome, hepatichydrothorax, portal vein thrombosis, and Budd-Chiari syndrome. Most of the previous studies on TIPS procedure were based on the use of bare stents and most patients chose TIPS 2-3 years after traditional treatment, thus making TIPS appear to be not superior to endoscopy in survival rates. Bare stents were associated with higher incidence of shunt failure and consequently patients required several revisions during the follow-up. With the introduction of a dedicated e-PTFE covered stent-graft, these problems were completely solved, No more reinterventions are required with a tremendous improvement of patient's quality of life. One of the main drawbacks of the use of e-PTFE covered stent-graft is higher incidence of hepatic encephalopathy. In those cases refractory to the conventional medical therapy, a shunt reduction must be performed.
Highlights
Portal hypertension is the result of pressure increase within the portal vein when the blood flowing through the liver is blocked
Refractory ascites is associated with a severe prognosis in patients with liver cirrhosis, firstly, because 1-year survival is less than 50% and risk of complications is very high
Most of the previous studies on transjugular intrahepatic portosystemic shunt (TIPS) procedure were based on the use of bare stents and most patients chose TIPS 2-3 years after traditional treatment, making TIPS appear to be not superior to endoscopy in survival rates
Summary
Portal hypertension is the result of pressure increase within the portal vein when the blood flowing through the liver is blocked. Transjugular intrahepatic portosystemic shunt dysfunction has been attributed to three different mechanisms: acute thrombosis within the stent; pseudointimal hyperplasia secondary to the biliary leaks of the lacerated bile ducts into the shunt lumen; and intimal hyperplasia in the outflow hepatic vein This problem was overcome when several experimental and clinical studies concentrated their research on improving covered stent-grafts whose use significantly bettered longterm patency of TIPS shunt. Shunt occlusion performed with different materials such as nonreadsorbable materials or occlusion balloons has been reported by Rose and Katz [89], Kerlan et al [90], and Haskal et al [91] This technique is associated with a high risk of variceal rebleeding, consequent to the irreversible increase of portal pressure as well as of portal thrombosis. The calibre of the shunt can be adjusted (increase in diameter only) during the follow-up according to the patient’s clinical conditions
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