📖 What is TIPS?
A TIPS (transjugular intrahepatic portosystemic shunt) is a channel created within the liver between the hepatic vein and the portal vein, using a covered metallic stent inserted via the jugular vein. It decompresses the portal venous system, reducing complications of portal hypertension.
TIPS is performed under conscious sedation, in the angiography suite. The procedure takes 1–2 hours. Patients are admitted for 48–72h of monitoring after the procedure.
🎯 Indications
- Refractory ascites — repeated paracentesis no longer adequate
- Acute variceal bleeding refractory to endoscopic treatment (rescue TIPS)
- Prevention of recurrent variceal haemorrhage (secondary prophylaxis)
- Budd-Chiari syndrome — hepatic vein occlusion
- Hepatorenal syndrome (HRS) — bridge to liver transplantation
- Portal vein thrombosis — in selected cases
❓ FAQs
TIPS itself is not easily reversible, but it can be narrowed (shunt reduction) or occluded if complications arise (particularly hepatic encephalopathy). Revision TIPS (re-stenting) is straightforward if the shunt thromboses.
Main risks: hepatic encephalopathy (new or worsening, in 20–35%), shunt thrombosis or stenosis (requiring revision), right heart failure (volume overload). All patients are discussed in a hepatology MDT before TIPS.
Modern covered PTFE-lined stents (Viatorr®) have primary patency rates of 80–90% at 2 years. Doppler ultrasound surveillance is performed at 1, 3, 6 and 12 months post-TIPS.
🔗 Related pages
🇫🇷 This page is also available in French: tips.html