TIPS technique

Abstract

Transjugular intrahepatic portosystemic shunts (TIPS) have become an accepted alternative to the conventional surgical portal decompression procedures for the management of complications related to portal hypertension. Though the precise technique of creating TIPS varies between institutions, the principle steps are similar. Selection of the hepatic vein is of critical importance, because each vein differs in its relationship to the main, right, and left portal veins. Targeting of the portal veins has been facilitated with the advent of wedged hepatic venography using carbon dioxide (CO2). After portal vein puncture, the hepatic parenchymal tract is dilated and bridged with a flexible metallic stent. With current techniques, TIPS can be established in more than 90% of patients. Minor modifications of this technique also allow for the successful creation of TIPS in patients with hepatic vein occlusion and portal vein occlusion. Transjugular intrahepatic portosystemic shunts (TIPS) have become an accepted alternative to the conventional surgical portal decompression procedures for the management of complications related to portal hypertension. Though the precise technique of creating TIPS varies between institutions, the principle steps are similar. Selection of the hepatic vein is of critical importance, because each vein differs in its relationship to the main, right, and left portal veins. Targeting of the portal veins has been facilitated with the advent of wedged hepatic venography using carbon dioxide (CO2). After portal vein puncture, the hepatic parenchymal tract is dilated and bridged with a flexible metallic stent. With current techniques, TIPS can be established in more than 90% of patients. Minor modifications of this technique also allow for the successful creation of TIPS in patients with hepatic vein occlusion and portal vein occlusion.