transjugular intrahepatic portasystemic shunt


Summary: A type of surgical portasystemic shunt to reduce portal hypertension with associated complications of esophageal varices and ascites. It is performed percutaneously through the jugular vein and involves the creation of an intrahepatic shunt between the hepatic vein and portal vein. The channel is maintained by a metallic stent. The procedure can be performed in patients who have failed sclerotherapy and is an additional option to the surgical techniques of portocaval, mesocaval, and splenorenal shunts. It takes one to three hours to perform. (JAMA 1995;273(23):1824-30)

Top Publications

  1. Bureau C, Garcia Pagan J, Otal P, Pomier Layrargues G, Chabbert V, Cortez C, et al. Improved clinical outcome using polytetrafluoroethylene-coated stents for TIPS: results of a randomized study. Gastroenterology. 2004;126:469-75 pubmed
    ..The use of polytetrafluoroethylene-covered prostheses improves transjugular intrahepatic portosystemic shunt patency and decreases the number of clinical relapses and reinterventions without increasing the risk of encephalopathy. ..
  2. Tripathi D, Helmy A, Macbeth K, Balata S, Lui H, Stanley A, et al. Ten years' follow-up of 472 patients following transjugular intrahepatic portosystemic stent-shunt insertion at a single centre. Eur J Gastroenterol Hepatol. 2004;16:9-18 pubmed
    ..0%). TIPSS is effective in the management of variceal bleeding, and has a low complication rate. With surveillance, good patency can be achieved. Careful selection of patients is needed to reduce the encephalopathy rate. ..
  3. Fanelli F, Salvatori F, Corona M, Bruni A, Pucci A, Boatta E, et al. Stent graft in TIPS: technical and procedural aspects. Radiol Med. 2006;111:709-23 pubmed
    ..8%. However the use of the stentgraft is correlate with a high rate of hepatic hencefalopathy (46.6 %). In case of hepatic hencefalopathy refractory to the conventional medical therapy, TIPS reduction should be performed. ..
  4. Bureau C, Garcia Pagan J, Layrargues G, 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;27:742-7 pubmed
    ..In conclusion, the improvement in TIPS patency by using covered prostheses is maintained over time with a decreased risk of encephalopathy, while the risk of death was not increased. ..
  5. Vangeli M, Patch D, Terreni N, Tibballs J, Watkinson A, Davies N, et al. Bleeding ectopic varices--treatment with transjugular intrahepatic porto-systemic shunt (TIPS) and embolisation. J Hepatol. 2004;41:560-6 pubmed
    ..Embolisation stopped bleeding in all but 1 patient. We recommend performing embolisation at the time of the initial TIPS to control bleeding from ectopic varices. ..
  6. Rabie R, Cazzaniga M, Salerno F, Wong F. The use of E/A ratio as a predictor of outcome in cirrhotic patients treated with transjugular intrahepatic portosystemic shunt. Am J Gastroenterol. 2009;104:2458-66 pubmed publisher
  7. Yoon C, Chung J, Park J. Transjugular intrahepatic portosystemic shunt for acute variceal bleeding in patients with viral liver cirrhosis: predictors of early mortality. AJR Am J Roentgenol. 2005;185:885-9 pubmed
    ..7 mg/dL; p =0.018; odds ratio, 12.0). Hyperbilirubinemia and elevated serum creatinine level are predictive of early mortality after TIPS creation for acute variceal bleeding in patients with viral liver cirrhosis. ..
  8. Helmy A, Redhead D, Stanley A, Hayes P. The natural history of parallel transjugular intrahepatic portosystemic stent shunts using uncovered stent: the role of host-related factors. Liver Int. 2006;26:572-8 pubmed
    ..3%) and 21 patients (52.5%) died during follow-up after a median period of 23.4 and 8.9 months respectively. These findings do not support the hypothesis that shunt insufficiency is related to host factors. ..
  9. Ferro C, Rossi U, Bovio G, Dahamane M, Centanaro M. Transjugular intrahepatic portosystemic shunt, mechanical aspiration thrombectomy, and direct thrombolysis in the treatment of acute portal and superior mesenteric vein thrombosis. Cardiovasc Intervent Radiol. 2007;30:1070-4 pubmed
    ..TIPS, mechanical aspiration thrombectomy, and direct thrombolysis together are promising endovascular techniques for the treatment of symptomatic acute PSMVT. ..

More Information


  1. Colombato L. The role of transjugular intrahepatic portosystemic shunt (TIPS) in the management of portal hypertension. J Clin Gastroenterol. 2007;41 Suppl 3:S344-51 pubmed
    ..Pre-TIPS evaluation taking into account predictors of outcome is mandatory. The improved results achieved with covered-stents might expand the currently accepted recommendations for TIPS use. ..
  2. Martinez Palli G, Drake B, García Pagán J, Barbera J, Arguedas M, Rodriguez Roisin R, et al. Effect of transjugular intrahepatic portosystemic shunt on pulmonary gas exchange in patients with portal hypertension and hepatopulmonary syndrome. World J Gastroenterol. 2005;11:6858-62 pubmed
    ..This data does not support the use of TIPS as a specific treatment for HPS. However, it does reinforce the view that TIPS can be safely performed for the treatment of other complications of portal hypertension in patients with HPS. ..
  3. Kessler J, Trerotola S. Use of the Amplatzer Vascular Plug for embolization of a large retroperitoneal shunt during transjugular intrahepatic portosystemic shunt creation for gastric variceal bleeding. J Vasc Interv Radiol. 2006;17:135-40 pubmed
    ..Two Amplatzer Vascular Plugs and two platinum coils were used to occlude the shunt rapidly and completely. ..
  4. Montgomery A, Ferral H, Vasan R, Postoak D. MELD score as a predictor of early death in patients undergoing elective transjugular intrahepatic portosystemic shunt (TIPS) procedures. Cardiovasc Intervent Radiol. 2005;28:307-12 pubmed
    ..The MELD score is useful in identifying patients at a higher risk of early death after an elective TIPS. On th basis of our results, we do not endorse elective TIPS in patients with MELD scores > 24. ..
  5. Cazzaniga M, Salerno F, Pagnozzi G, Dionigi E, Visentin S, Cirello I, et al. Diastolic dysfunction is associated with poor survival in patients with cirrhosis with transjugular intrahepatic portosystemic shunt. Gut. 2007;56:869-75 pubmed
    ..Diastolic dysfunction estimated using E/A ratio is a promising predictor of death in patients with cirrhosis who are treated with TIPS. ..
  6. Arroyo V, Fernandez J, Gines P. Pathogenesis and treatment of hepatorenal syndrome. Semin Liver Dis. 2008;28:81-95 pubmed publisher
    ..However, effective treatments of HRS (vasoconstrictors associated with intravenous albumin, transjugular intrahepatic portacaval shunt, albumin dialysis) that can improve survival have recently been introduced. ..
  7. Alkari B, Shaath N, El Dhuwaib Y, Aboutwerat A, Warnes T, Chalmers N, et al. Transjugular intrahepatic porto-systemic shunt and variceal embolisation in the management of bleeding stomal varices. Int J Colorectal Dis. 2005;20:457-62 pubmed
    ..TIPS and variceal embolisation do not preclude subsequent liver transplantation, and may be used during the acute situation as a bridge to transplantation. ..
  8. Helton W, Maves R, Wicks K, Johansen K. Transjugular intrahepatic portasystemic shunt vs surgical shunt in good-risk cirrhotic patients: a case-control comparison. Arch Surg. 2001;136:17-20 pubmed
    ..surgical shunt is more effective, more durable, and less costly than angiographic shunt (transjugular intrahepatic portasystemic shunt [TIPS]). Retrospective case-control study. Academic referral center for liver disease...
  9. Ryu R, Nemcek A, Chrisman H, Saker M, Blei A, Omary R, et al. Treatment of stomal variceal hemorrhage with TIPS: case report and review of the literature. Cardiovasc Intervent Radiol. 2000;23:301-3 pubmed
    ..Although several treatment options have been reported for this entity we believe that TIPS offers minimally invasive and definitive treatment. ..
  10. Schepke M, Roth F, Fimmers R, Brensing K, Sudhop T, Schild H, et al. Comparison of MELD, Child-Pugh, and Emory model for the prediction of survival in patients undergoing transjugular intrahepatic portosystemic shunting. Am J Gastroenterol. 2003;98:1167-74 pubmed
    ..67-0.89; Child-Pugh: c-statistic 0.67, 95% CI = 0.55-0.80, p = 0.059). The MELD model is superior to the Emory score but only slightly superior to the Child-Pugh classification for the prediction of long-term survival in TIPS patients. ..
  11. Angermayr B, Cejna M, Karnel F, Gschwantler M, Koenig F, Pidlich J, et al. Child-Pugh versus MELD score in predicting survival in patients undergoing transjugular intrahepatic portosystemic shunt. Gut. 2003;52:879-85 pubmed
    ..For assessing prognosis in patients undergoing TIPS implantation, there seems little reason to replace the well established Child-Pugh score. ..
  12. Burroughs A, Vangeli M. Transjugular intrahepatic portosystemic shunt versus endoscopic therapy: randomized trials for secondary prophylaxis of variceal bleeding: an updated meta-analysis. Scand J Gastroenterol. 2002;37:249-52 pubmed
  13. Merli M, Valeriano V, Funaro S, Attili A, Masini A, Efrati C, et al. Modifications of cardiac function in cirrhotic patients treated with transjugular intrahepatic portosystemic shunt (TIPS). Am J Gastroenterol. 2002;97:142-8 pubmed
  14. Seong C, Kim Y, Shin T, Park H, Kim T, Kang D. Transcaval TIPS in patients with failed revision of occluded previous TIPS. Korean J Radiol. 2001;2:204-9 pubmed
    ..After successful shunt creation, variceal bleeding ceased in all patients. Transcaval TIPS placement is an effective and safe alternative treatment in patients with occluded previous TIPS and no hepatic veins suitable for new TIPS. ..
  15. Brensing K, Raab P, Textor J, Görich J, Schiedermaier P, Strunk H, et al. Prospective evaluation of a clinical score for 60-day mortality after transjugular intrahepatic portosystemic stent-shunt: Bonn TIPSS early mortality analysis. Eur J Gastroenterol Hepatol. 2002;14:723-31 pubmed
    ..BOTEM score based on bilirubin, comorbidity and TIPSS-urgency predicts rather reliably post-TIPSS 60-day mortality and might optimize TIPSS treatment. ..
  16. Rajan D, Haskal Z, Clark T. Serum bilirubin and early mortality after transjugular intrahepatic portosystemic shunts: results of a multivariate analysis. J Vasc Interv Radiol. 2002;13:155-61 pubmed
    ..The magnitude of the effect on mortality is similar to that of APACHE II scores and modified Child-Pugh class but is simpler to ascertain. ..
  17. de Franchis R, Dell Era A, Fabris F, Iannuzzi F, Fazzini L, Sotela J, et al. Medical treatment of portal hypertension. Acta Gastroenterol Belg. 2004;67:334-43; discussion 344-5 pubmed
    ..Liver transplantation should be considered for patients with severe liver insufficiency in which first-line treatments fail. ..
  18. La Mura V, Abraldes J, Berzigotti A, Erice E, Flores Arroyo A, Garcia Pagan J, et al. Right atrial pressure is not adequate to calculate portal pressure gradient in cirrhosis: a clinical-hemodynamic correlation study. Hepatology. 2010;51:2108-16 pubmed publisher
    ..The excellent prognostic information provided by HVPG response to drug therapy is lost if HAPG response is considered. RAP should not be used for the calculation of portal pressure gradient in patients with cirrhosis. ..
  19. Dhanasekaran R, West J, Gonzales P, Subramanian R, Parekh S, Spivey J, et al. Transjugular intrahepatic portosystemic shunt for symptomatic refractory hepatic hydrothorax in patients with cirrhosis. Am J Gastroenterol. 2010;105:635-41 pubmed publisher
    ..We sought to study effectiveness, survival, and complications after transjugular intrahepatic portosystemic shunt (TIPS) in patients with cirrhosis and symptomatic refractory hepatic hydrothorax...
  20. Hoekstra J, Leebeek F, Plessier A, Raffa S, Darwish Murad S, Heller J, et al. Paroxysmal nocturnal hemoglobinuria in Budd-Chiari syndrome: findings from a cohort study. J Hepatol. 2009;51:696-706 pubmed publisher
    ..Treatment with TIPS can be safely performed in patients with PNH. Stem cell transplantation appears to be a feasible treatment option for PNH in BCS patients. ..
  21. Al Hamoudi W. Cardiovascular changes in cirrhosis: pathogenesis and clinical implications. Saudi J Gastroenterol. 2010;16:145-53 pubmed publisher
    ..The following is a review of the pathogenesis and clinical implications of the cardiovascular changes in cirrhosis. ..
  22. Cura M. Refractory hepatic encephalopathy due to concomitant transjugular intrahepatic portosystemic shunt and spontaneous mesocaval shunt controlled by embolization of the competitive portosystemic shunt. Clin Imaging. 2009;33:231-3 pubmed publisher
    ..Percutaneous transhepatic occlusion of the SMCS reduced the portal vein flow diverted from the liver and provided sufficient liver perfusion to reverse the HE while maintaining satisfactory decompression of esophageal varices. ..
  23. Senzolo M, Cholongitas E, Davies N, Marelli L, Shusang V, Patch D, et al. Transjugular Intrahepatic Portosystemic Shunt (TIPS), the preferred therapeutic option for Budd Chiari syndrome associated with portal vein thrombosis. Am J Gastroenterol. 2006;101:2163-4; author reply 2164-5 pubmed
  24. Anstead G, Martinez M, Graybill J. Control of a Candida glabrata prosthetic endovascular infection with posaconazole. Med Mycol. 2006;44:273-7 pubmed
    ..glabrata infection. Posaconazole had controlled the infection for about 3 months prior to his death. In conclusion, posaconazole may be a useful option in the management of prosthetic endovascular infections caused by C. glabrata. ..
  25. Aalykke C, Tønner Nielsen D, Vilstrup H. [TIPS is a life-prolonging treatment of those cirrhosis patients with ascites who can not be treated medically or with paracentesis]. Ugeskr Laeger. 2005;167:4197; author reply 4198-9 pubmed
  26. Rosemurgy A, Bloomston M, Clark W, Thometz D, Zervos E. H-graft portacaval shunts versus TIPS: ten-year follow-up of a randomized trial with comparison to predicted survivals. Ann Surg. 2005;241:238-46 pubmed
    ..This trial irrefutably establishes a role for surgical shunting, particularly HGPCS. ..
  27. Membreno F, Baez A, Pandula R, Walser E, Lau D. Differences in long-term survival after transjugular intrahepatic portosystemic shunt for refractory ascites and variceal bleed. J Gastroenterol Hepatol. 2005;20:474-81 pubmed
    ..Mexican-Americans had an improved long-term survival compared with Caucasians. The reason for this ethnic difference in survival is unclear and warrants further prospective evaluation. ..
  28. Schemmer P, Radeleff B, Flechtenmacher C, Mehrabi A, Richter G, Buchler M, et al. TIPSS for variceal hemorrhage after living related liver transplantation: a dangerous indication. World J Gastroenterol. 2006;12:493-5 pubmed
    ..CT scan revealed substantial necrosis in the liver. The patient underwent successful "high urgent" cadaveric liver transplantation and was discharged on postoperative d 20 in a stable condition. ..
  29. Vizzutti F, Arena U, Rega L, Zipoli M, Abraldes J, Romanelli R, et al. Liver failure complicating segmental hepatic ischaemia induced by a PTFE-coated TIPS stent. Gut. 2009;58:582-4 pubmed publisher
    ..Moreover, we discuss the possible involvement of additional pathogenetic mechanisms other than out-flow obstruction in the onset of coated-stent induced congestive liver ischaemia. ..
  30. Cura M, Cura A, Suri R, El Merhi F, Lopera J, Kroma G. Causes of TIPS dysfunction. AJR Am J Roentgenol. 2008;191:1751-7 pubmed publisher
    ..The combination of improved technique and expandable PTFE has significantly improved TIPS patency. The need for follow-up venography and secondary interventions has been reduced significantly as a result of improved shunt patency. ..
  31. Wehbe E, Saad D, Delgado F, Ta H, Antoun S. Reversible hepatic decerebration: a case report and review of the literature. Eur J Gastroenterol Hepatol. 2010;22:759-60 pubmed publisher
    ..The physician should be aware that decerebration and decortication posture can occur with hepatic encephalopathy and can be reversible...
  32. Lopez Benitez R, Seidensticker P, Richter G, Stampfl U, Hallscheidt P. [Case report: massive lower intestinal bleeding from ileal varices: treatment with transjugular intrahepatic portosystemic shunt (TIPSS)]. Radiologe. 2007;47:407-10 pubmed
    ..The accurate angiographic and computed tomography diagnosis allowed fast decompression of the portal venous system using a transjugular intrahepatic portosystemic shunt. ..
  33. Al Hamad A, Kabbani A, Al Kadhi Y. N-butyl-2-cyanoacrylate (Histoacryl) complication: a case report. Ann Saudi Med. 2006;26:71-2 pubmed
  34. Poordad F. Review article: the burden of hepatic encephalopathy. Aliment Pharmacol Ther. 2007;25 Suppl 1:3-9 pubmed
    ..Thus, there is need for future studies to more accurately define the burden of hepatic encephalopathy, including minimal hepatic encephalopathy. ..
  35. Wittkugel O, Koops A, Habermann C, Weiss F, Adam G, Krupski G. Bile resistance of coated transjugular intrahepatic portosystemic shunt stents in a flow-model. Invest Radiol. 2004;39:717-22 pubmed
    ..The bile resistance of coated TIPS stents and, thus, the dependency of TIPS shunt patency is called into question. The stent with the reported superior patency rates does not show experimental bile resistance. ..
  36. D Amico M, Berzigotti A, Garcia Pagan J. Refractory acute variceal bleeding: what to do next?. Clin Liver Dis. 2010;14:297-305 pubmed publisher
  37. Ruh J, Malago M, Busch Y, Lang H, Paul A, Verhagen R, et al. Management of Budd-Chiari syndrome. Dig Dis Sci. 2005;50:540-6 pubmed
    ..If venous outflow cannot be interventionally restored and liver function deteriorates or cirrhosis develops during this time course, liver transplantation is the therapy of choice. ..
  38. Bloemen J, Olde Damink S, Venema K, Buurman W, Jalan R, Dejong C. Short chain fatty acids exchange: Is the cirrhotic, dysfunctional liver still able to clear them?. Clin Nutr. 2010;29:365-9 pubmed publisher
    ..This suggests that prebiotics can be administered safely, but monitoring butyrate levels may be advisable in patients with diminished liver function. ..
  39. Clark T. Management of shunt dysfunction in the era of TIPS endografts. Tech Vasc Interv Radiol. 2008;11:212-6 pubmed publisher
    ..The interventional radiologist needs to be aware of these patterns of shunt dysfunction and have a systematic approach to their management. ..
  40. Piliere G, Van Horn M, Dixon R, Stavas J, Aylward S, Bullitt E. Vessel target location estimation during the TIPS procedure. Med Image Anal. 2009;13:519-29 pubmed publisher
  41. Nayar M, Saravanan R, Rowlands P, McWilliams R, Evans J, Sutton R, et al. TIPSS in the treatment of ectopic variceal bleeding. Hepatogastroenterology. 2006;53:584-7 pubmed
    ..Those with advanced liver disease (Childs B & C) have a uniformly poor outcome. In these patients ectopic variceal hemorrhage is likely to represent a terminal event. ..
  42. van Buuren H, Wils A, Rauws E, van Hoek B, Drenth J, Kuipers E, et al. [Dutch study on the optimal treatment strategy for patients with a first or second occurrence of gastro-oesophageal variceal bleeding: the TIPS-TRUE trial]. Ned Tijdschr Geneeskd. 2008;152:643-5 pubmed
    ..TIPS will be performed in 4 university centres with relevant expertise. The trial will hopefully gain nationwide support, and all centres in The Netherlands are cordially invited to participate. ..
  43. Wroblewski T, Rowinski O, Ziarkiewicz Wroblewska B, Gornicka B, Albrecht J, Jones E, et al. Two-stage transjugular intrahepatic porta-systemic shunt for patients with cirrhosis and a high risk of portal-systemic encephalopathy patients as a bridge to orthotopic liver transplantation: a preliminary report. Transplant Proc. 2006;38:204-8 pubmed
    ..A two-stage TIPS procedure may be the method of choice for treating bleeding from esophageal varices in patients who have a high risk of developing PSE and give them a chance for liver transplantation. ..
  44. Lopera J, Arthurs B, Scheuerman C, Sandoz C, Petersosn S, Castaneda Zuniga W. Bleeding duodenal: varices treatment by TIPS and transcatheter embolization. Cardiovasc Intervent Radiol. 2008;31:431-4 pubmed
    ..The clinical presentation, imaging findings, and potential therapeutic management are discussed. ..
  45. McAvoy N, Hayes P. The use of transjugular intrahepatic portosystemic stent shunt in the management of acute oesophageal variceal haemorrhage. Eur J Gastroenterol Hepatol. 2006;18:1135-41 pubmed
    ..A management algorithm is proposed. The timing of intervention is emphasized and the importance of admission to specialized centres. Regional protocols are probably essential for the latter to be organized effectively. ..
  46. Kochar N, Tripathi D, McAvoy N, Ireland H, Redhead D, Hayes P. Bleeding ectopic varices in cirrhosis: the role of transjugular intrahepatic portosystemic stent shunts. Aliment Pharmacol Ther. 2008;28:294-303 pubmed
    ..A significant proportion of patients have rebleeding despite a patent shunt, when other adjunctive measures like thrombin injection may be tried. ..
  47. Finkenstedt A, Graziadei I, Nachbaur K, Jaschke W, Mark W, Margreiter R, et al. Transjugular intrahepatic portosystemic shunt in liver transplant recipients. World J Gastroenterol. 2009;15:1999-2004 pubmed
    ..Nevertheless, survival rates were disappointing, most probably because of the advanced stages of liver disease at the time of TIPS placement and the high risk of sepsis as a consequence of immunosuppression. ..
  48. Pan J, Chen C, Geller B, Firpi R, Machicao V, Caridi J, et al. Is sonographic surveillance of polytetrafluoroethylene-covered transjugular intrahepatic portosystemic shunts (TIPS) necessary? A single centre experience comparing both types of stents. Clin Radiol. 2008;63:1142-8 pubmed publisher
    ..Considering the improved patency of covered stents in TIPS, US surveillance may be superfluous after the baseline study. ..
  49. Ferraz Neto B, Zurstrassen M, Hidalgo R, Meira Filho S, Rezende M, Paes A, et al. Analysis of liver transplantation outcome in patients with MELD Score > or = 30. Transplant Proc. 2008;40:797-9 pubmed publisher
    ..The 30-day survivals were 93.3% for group I and 84.37% for group II. Besides the increased complexity of these sickest patients, there was no negative impact on early survival rates. ..
  50. Spier B, Fayyad A, Lucey M, Johnson E, Wojtowycz M, Rikkers L, et al. Bleeding stomal varices: case series and systematic review of the literature. Clin Gastroenterol Hepatol. 2008;6:346-52 pubmed publisher
    ..Once identified, conservative measures will stop bleeding temporarily with definitive therapy required, including transjugular intravascular transhepatic shunts, surgical shunts, or liver transplantation. ..
  51. Perkins J. Indications for chronic albumin infusion. Liver Transpl. 2006;12:320-1 pubmed
  52. Blei A. Portal hypertension and its complications. Curr Opin Gastroenterol. 2007;23:275-82 pubmed
    ..Significant advances continue to be made in the diagnosis and management of the complications of portal hypertension in the face of an increasing burden of chronic liver disease. ..
  53. López Méndez E, Chavez Tapia N, Avila Escobedo L, Cabrera Aleksandrova T, Uribe M. Early experience of Budd-Chiari syndrome treatment with transjugular intrahepatic portosystemic shunt. Ann Hepatol. 2006;5:157-60 pubmed
    ..To our knowledge this is the first time that transjugular intrahepatic portosystemic shunt are used and reported in Budd-Chiari syndrome in Mexico. ..