Abstract
Transjugular intrahepatic portosystemic shunt (TIPS) is the percutaneous method of creating a portosystemic shunt to decrease or treat portal hypertension. TIPS is a side-to-side shunt of a determined diameter designed to functioon as a partial shut that preserves a portion of portal flow to the live.
Flow through the completed shunt is assessed by comparing the degree of preferential filing of the shunt to the that of the portal vein branches and portosystemic collaterals (mainly in the gastric vens). The identificatoion of hepatogufal (reversed) blood flow in portal vein branches (total shunting) is a sign of good flow through the shunt.
Generally, patients, with a Child-Pugh score of > 12 are in high risk of portprocedural death. A thorough selection of patients is the key to successful treatment with TIPS.
Scoring of patients by the model of end-stage liver disease (MELD) has been validated to predict early mortality after TIPS. Patients with MELD scores of > 15-18 or a bilirubin level of > 60umol/L (3,5 mg/dl) should be informed of their poor prognosis, and TIPS should only be performed in the absence of any other treatment possibilities.