Transjugular intrahepatic portosystemic shunts: current status

The management of acute variceal hemorrhage from portal hypertension has traditionally included pharmacologic agents, mechanical compression with tamponading balloons, and endoscopic techniques including sclerotherapy and variceal banding. The role of operative portosystemic shunting has diminished in the past several years because of unpredictable postoperative morbidity from hepatic failure or encephalopathy [1-8]. Although orthotopic liver transplantation provides a unique and effective solution to these problems, it is often impractical in the emergent setting and may not be necessary if the hemorrhage can be reliably controlled by other means. The transjugular intrahepatic portosystemic shunt (TIPS) was developed to relieve portal hypertension without the mortality and morbidity of an open surgical procedure. This review summarizes the salient history, technique, and results of this procedure. The evolving role of TIPS in the management of portal hypertension, including indications, contraindications, and the durability of the procedure, is assessed.