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Evolving Indications for Tips.

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Transjugular intrahepatic portosystemic shunt (TIPS) creation is effective for refractory ascites and variceal bleeding. Expanded applications include prophylaxis and treating other rare conditions, potentially increasing TIPS procedure frequency.

Keywords:
TIPS indicationscirrhotic asciteshigh-risk variceal bleedingportal hypertension complications

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Area of Science:

  • Interventional Radiology
  • Hepatology
  • Gastroenterology

Background:

  • Transjugular intrahepatic portosystemic shunt (TIPS) creation is a standard treatment for refractory ascites and variceal bleeding.
  • Technical advancements, such as covered stents, have improved TIPS outcomes and expanded its applications.
  • Growing evidence supports TIPS for less common indications.

Purpose of the Study:

  • To review the established and emerging indications for TIPS procedures.
  • To discuss the potential expansion of TIPS utilization in clinical practice.
  • To highlight the role of TIPS in managing complex liver disease complications.

Main Methods:

  • Literature review of current evidence and clinical experience with TIPS.
  • Analysis of outcomes for various indications, including refractory ascites, variceal bleeding, and other conditions.
  • Discussion of factors influencing the frequency of TIPS procedures.

Main Results:

  • TIPS is well-established for refractory variceal bleeding and ascites unresponsive to paracentesis.
  • Emerging indications include primary prophylaxis, gastric/ectopic varices, post-transplant ascites, hepatic hydrothorax, hepatorenal syndrome, Budd-Chiari syndrome, and portal vein thrombosis.
  • Early TIPS for high-risk variceal bleeding and primary ascites treatment are likely to increase procedure frequency.

Conclusions:

  • TIPS is a versatile procedure with established and expanding indications in liver disease management.
  • Early intervention with TIPS may improve outcomes for high-risk variceal bleeding and refractory ascites.
  • While some indications are rare, the overall utility of TIPS continues to grow.