Transjugular Intrahepatic Portosystemic Shunt

This chapter presents equipment/device, indications, contraindications, management, complications, and consultation of transjugular intrahepatic portosystemic shunt. The transjugular intrahepatic portosystemic shunt (TIPS) is an interventional radiology procedure where a stent is inserted to ameliorate the complications from portal hypertension. The TIPS creates an artificial channel between the portal vein and the hepatic vein, thereby decreasing the resistance of blood flow returning to the systemic circulation. The TIPS device is used to combat the downstream effects of portal hypertension. Most patients with portosystemic shunt related hepatic encephalopathy present two to three weeks after the TIPS procedure. Worsening liver function due to the underlying liver disease can cause a decrease in hepatic production of clotting factors. Patients presenting with an increase in jaundice after TIPS placement should be evaluated for hemolysis. Mechanical complications of TIPS stents, including occlusion or malplacement that leads to worsening liver disease, will need to be addressed with interventional radiology.