Interventions for Portal Hypertension: Trans Jugular Intrahepatic Portosystemic Shunts (TIPS)

  • Munawwar Ahmed
  • Shyamkumar N. Keshava


Transjugular intrahepatic portosystemic shunt (TIPS) is an effective and safe radiological procedure for the decompression of portal hypertension (PHT) where a shunt is created between the portal vein (PV) and a hepatic vein or IVC. It is a well-established treatment option for the management of the gastroesophageal variceal bleeding and refractory ascites due to cirrhosis-related PHT. With the improvement in the techniques and stent design, TIPS for many other indications are being performed with promising results. Use of real-time ultrasonography (USG) during access to PV improves the success rate and reduces complications.


  1. 1.
    Rösch J. Development of Transjugular intrahepatic Portosystemic shunt. JVIR. 2015;26(2):220–2.CrossRefGoogle Scholar
  2. 2.
    Rösch J, Hanafee WN, Snow H. Transjugular portal venography and radiologic Portacaval shunt: an experimental study. Radiology. 1969;92(5):1112–4.CrossRefGoogle Scholar
  3. 3.
    Nishimine K, Saxon RR, Kichikawa K, Mendel-Hartvig J, Timmermans HA, Shim HJ, et al. Improved transjugular intrahepatic portosystemic shunt patency with PTFE-covered stent-grafts: experimental results in swine. Radiology. 1995;196(2):341–7.CrossRefGoogle Scholar
  4. 4.
    Saad WE, Saad NE, Davies MG, Bozorgdadeh A, Orloff MS, Patel NC, Abt PL, Lee DE, Sahler LG, Kitanosono T, Sasson T, Waldman DL. Elective transjugular intrahepatic portosystemic shunt creation for portal decompression in the immediate pretransplantation period in adult living related liver transplant recipient candidates: preliminary results. JVIR. 2006;17(6):995–1002.CrossRefGoogle Scholar
  5. 5.
    Livingstone RS, Keshava SN. Technical note: reduction of radiation dose using ultrasound guidance during transjugular intrahepatic portosystemic shunt procedure. Indian J Radiol Imaging. 2011;21:13–4.CrossRefGoogle Scholar
  6. 6.
    Boyer TD, Haskal ZJ. The role of Transjugular intrahepatic Portosystemic shunt (TIPS) in the Management of Portal Hypertension. Hepatology. 2010;51(1):1–16.CrossRefGoogle Scholar
  7. 7.
    Dariushnia SR, Haskal ZJ, Midia M, Martin LG, Walker TG, Kalva SP, Clark TW, Ganguli S, Krishnamurthy V, Saiter CK, Nikolic B. Quality improvement guidelines for Transjugular intrahepatic Portosystemic shunts. J Vasc Interv Radiol. 2016;27(1):1–78.CrossRefGoogle Scholar
  8. 8.
    Garcia-Pagan JC, Caca K, Bureau C, Laleman W, Appenrodt B, Luca A. Etal.Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med. 2010;362:2370–9.CrossRefGoogle Scholar
  9. 9.
    Cirrhotic patients with portal hypertension-related bleeding and an indication for early-TIPS: a large multicentre audit with real-life results. J Hepatol. 2018;68(1):73–81.Google Scholar
  10. 10.
    Garcia-Pagán JC, Di Pascoli M, Caca K, Laleman W. Use of early-TIPS for high-risk variceal bleeding: results of apost-RCT surveillance study. J Hepatol. 2013;58(1):45–50.CrossRefGoogle Scholar
  11. 11.
    Halabi SA, Sawas T, Sadat B, Jandali A, Halabi HA, Halabi FA, Kapoor B, Carey WD. Early TIPS versus endoscopic therapy for secondary prophylaxis after management of acute esophageal variceal bleeding in cirrhotic patients: a meta-analysis of randomized controlled trials. J Gastroenterol Hepatol. 2016 Sep;31(9):1519–26.CrossRefGoogle Scholar
  12. 12.
    Spencer EB, Cohen DT, Darcy MD. Safety and efficacy of transjugular intrahepatic portosystemic shunt creation for the treatment of hepatic hydrothorax. J Vasc Interv Radiol. 2002 Apr;13(4):385–90.CrossRefGoogle Scholar
  13. 13.
    Wilputte JY, Goffette P, Zech F, Godoy-Gepert A, Geubel A. The outcome after transjugular intrahepatic portosystemic shunt (TIPS) for hepatic hydrothorax is closely related to liver dysfunction: a long-term study in 28 patients. Acta Gastroenterol Belg. 2007;70:6–10.PubMedGoogle Scholar
  14. 14.
    Siegerstetter V, Deibert P, Ochs A, Olschewski M, Blum HE, Rössle M. Treatment of refractory hepatic hydrothorax with transjugular intrahepatic portosystemic shunt: long-term results in 40 patients. Eur J Gastroenterol Hepatol. 2001 May;13(5):529–34.CrossRefGoogle Scholar
  15. 15.
    Dhanasekaran R, West JK, Gonzales PC, Subramanian R, Parekh S, Spivey JR, Martin LG, Kim HS. Transjugular intrahepatic portosystemic shunt for symptomatic refractory hepatic hydrothorax in patients with cirrhosis. Am J Gastroenterol. 2010 Mar;105(3):635–41.CrossRefGoogle Scholar
  16. 16.
    Seijo S, Plessier A, Hoekstra J, et al. Good long-term outcome of Budd-Chiari syndrome with a step-wise management. Hepatology. 2013;57(5):1962–8.CrossRefGoogle Scholar
  17. 17.
    Rössle M, Olschewski M, Siegerstetter V, Berger E, Kurz K, Grandt D. The Budd-Chiari syndrome: outcome after treatment with the transjugular intrahepatic portosystemic shunt. Surgery. 2004;135(4):394–403.CrossRefGoogle Scholar
  18. 18.
    Garcia-Pagán JC, Heydtmann M, Raffa S, et al. TIPS for Budd-Chiari syndrome: long-term results and prognostics factors in 124 patients. Gastroenterology. 2008;135(3):808–15.CrossRefGoogle Scholar
  19. 19.
    Keshava SN, Kota GK, Mammen T, Jeyamani R, Moses V, Govil S, Kurian G, Chandy G. Direct intrahepatic cavo-portal shunts in Budd-Chiari syndrome: role of simultaneous fluoroscopy and trans-abdominal ultrasonography. Indian J Gastroenterol. 2006 Sep-Oct;25(5):248–50.PubMedGoogle Scholar
  20. 20.
    Ahmed M, Keshava SN, Moses V, Chiramel GK, Mammen S, Eapen CE, Zachariah UG. Transjugular intrahepatic Portosystemic shunt through the strut of a previously placed stent: technical feasibility and long-term follow-up results. Cardiovasc Intervent Radiol. 2018 Nov;41(11):1794–8.CrossRefGoogle Scholar
  21. 21.
    Surendrababu NR, Keshava SN, Eapen CE, Zachariah UG. Transjugular intrahepatic portocaval shunt placed through the strut of an inferior vena cava stent in a patient with Budd-Chiari syndrome: a technical modification. Br J Radiol. 2010 Jan;83(985):e22–4.CrossRefGoogle Scholar
  22. 22.
    Mammen S, Keshava SN, Kattiparambil S. Acute portal vein thrombosis, no longer a contraindication for Transjugular intrahepatic Porto-systemic shunt (TIPS) insertion. J Clin Exp Hepatol. 2015;5(3):259–61.CrossRefGoogle Scholar
  23. 23.
    Systematic review and meta-analysis: portal vein recanalisation and transjugular intrahepatic portosystemic shunt for portal vein thrombosis. Aliment Pharmacol Ther. 2018:1–11.Google Scholar
  24. 24.
    Song T, Rössle M, He F, Liu F, Guo X, Qi X. Transjugular intrahepatic portosystemic shunt in hepatorenal syndrome: a systemic review and meta-analysis. Dig Liver Dis. 2018;50(4):323–30.CrossRefGoogle Scholar
  25. 25.
    Tsauo J, Weng N, Ma H, Jiang M, Zhao H, Li X. Role of Transjugular intrahepatic Portosystemic shunts in the Management of Hepatopulmonary Syndrome: a systemic literature review. J Vasc Interv Radiol. 2015;26(9):1266–71.CrossRefGoogle Scholar
  26. 26.
    Strunk H, Marinova M. Transjugular intrahepatic Portosystemic shunt (TIPS): pathophysiologic basics, ActualIndications and results with review of the literature. Rofo. 2018 Aug;190(8):701–11.CrossRefGoogle Scholar
  27. 27.
    Copelan A, Kapoor B, Sands M. Transjugular intrahepatic portosystemic shunt: indications, contraindications, and patient work-up. Semin Intervent Radiol. 2014;31(3):235–42.CrossRefGoogle Scholar
  28. 28.
    Farsad K, Kaufman JA. Novel image guidance technique for portal vein targeting during transjugular intrahepatic portosystemic shunt creation. Tech Vasc Interv Radiol. 2016;19(1):10–20.CrossRefGoogle Scholar
  29. 29.
    Fidelman N, Kwan SW, JM LB, Gordon RL, Ring EJ, Kerlan RK Jr. Thetransjugular intrahepatic portosystemic shunt: an update. AJR Am J Roentgenol. 2012;199:746–55.CrossRefGoogle Scholar
  30. 30.
    Farsad K, Fuss C, Kolbeck KJ, Barton RE, Lakin PC, Keller FS, Kaufman JA. Transjugular intrahepatic portosystemic shunt creation using intravascular ultrasound guidance. J Vasc Interv Radiol. 2012;23(12):1594–602.CrossRefGoogle Scholar
  31. 31.
    Bureau C, Garcia Pagan JC, Layrargues GP, Metivier S, Bellot P, Perreault P, et al. Patency of stents covered with polytetrafluoroethylene in patients treated by transjugular intrahepatic portosystemic shunts: long-term results of a randomized multicentre study. Liver Int. 2007;27(6):742–7.CrossRefGoogle Scholar
  32. 32.
    Wang L, Xiao Z, Yue Z, Zhao H, Fan Z, Zhao M, et al. Efficacy of covered and bare stent in TIPS for cirrhotic portal hypertension: a single-center randomized trial. Sci Rep. 2016;6:21011.CrossRefGoogle Scholar
  33. 33.
    Luo X, Zhao M, Wang X, Jiang M, Yu J, Li X, et al. Long-termpatencyand clinical outcome of the transjugular intrahepatic portosystemic shunt using the expanded polytetrafluoroethylene stent-graft. PLoS One. 2019;14(2):e0212658.CrossRefGoogle Scholar
  34. 34.
    Perarnau J, Le Gouge A, Nicolas C, D’Alteroche L, Borentain P, Saliba F, et al. Covered vs. uncovered stents for transjugular intrahepatic portosystemic shunt: a randomized controlled trial. J Hepatol. 2014;60:962–8.CrossRefGoogle Scholar
  35. 35.
    Qi X, Tian Y, Zhang W, et al. Covered versus bare stents for transjugular intrahepatic portosystemic shunt: an updated meta-analysis of randomized controlled trials. Therap Adv Gastroenterol. 2017;10:32–41.CrossRefGoogle Scholar
  36. 36.
    Zhuang ZW, Teng GJ, Jeffery RF, Gemery JM, Janned’Othee B, Bettmann MA. Long-term results and quality of life in patients treated with transjugular intrahepatic portosystemic shunts. Am J Roentgenol. 2002;179(6):1597–603.CrossRefGoogle Scholar
  37. 37.
    Brand M, Prodehl L, Ede CJ. Surgical portosystemic shunts versus transjugular intrahepatic portosystemic shunt for variceal haemorrhage in people with cirrhosis. Cochrane Database Syst Rev. 2018 Oct 31;10:CD001023.PubMedGoogle Scholar
  38. 38.
    Menegaux F, Keeffe EB, Baker E, et al. Comparison of Transjugular and surgical Portosystemic shunts on the outcome of liver transplantation. Arch Surg. 1994;129(10):1018–24.CrossRefGoogle Scholar
  39. 39.
    AbouljoudMS A. Comparison of treatment with transjugular intrahepatic portosystemic shunt or distal splenorenal shunt in the management of variceal bleeding prior to liver transplantation. Transplantation. 1995;59(2):226–9.CrossRefGoogle Scholar
  40. 40.
    Haskal ZJ, Duszak R Jr, Furth EE. Transjugular intrahepatic transcaval portosystemic shunt: the gun-sight approach. J Vasc Interv Radiol. 1996;7(1):139–42.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2021

Authors and Affiliations

  • Munawwar Ahmed
    • 1
  • Shyamkumar N. Keshava
    • 1
  1. 1.Department of RadiologyChristian Medical College HospitalVelloreIndia

Personalised recommendations