Therapy of portal hypertension using transjugular intrahepatic portosystemic shunt - first 1,000 procedures in UH Hradec Kralove
Abstract
Transjugular intrahepatic portosystemic shunt (TIPS) has been available for clinical practice since 1989, and in the Czech Republic since 1992. It is mostly used in patients suffering from liver cirrhosis and related complications such as GI bleeding or large ascites.
In fact it is a side-to-side portacaval anastomosis reinforced with a metal stent and created by interventional radiologist without surgery. In the course of the 25 years of its clinical use, some changes have occurred: more than one-third of patients suffer from hepatic encephalopathy, but treatment with rifaximin is successful in most of them.
The bare stent used for TIPS in the initial period, having a much higher risk of patency problems, was replaced by a covered stent (stent-graft). Though many indications were specified, some others still await confirmation, e.g. indication of TIPS according to the portacaval gradient.
In the latest period, the number of indications not improve liver function, so it cannot substitute liver transplantation. TIPS is performed by an interventional radiologist, but cooperation with the hepatologist is a fundamental condition for good treatment of patients.
For the time of its existence, TIPS has established a firm position in the therapy for GI bleeding is decreasing, but the number of procedures for ascites and hydrothorax, having more altered liver functions, is rising. TIPS reduces portal pressure and has its form indication of portal hypertension complications.