ABSTRACT
In its early stages, the transjugular intrahepatic portosystemic shunt (TIPS) was
utilized as a lifesaving procedure to treat uncontrollable esophageal variceal bleeding.
Most of the initial cases were performed in an emergency situation in the worst possible
conditions. The experience gained over the past 15 years has established TIPS as an
important therapeutic option in the management of patients with complications of portal
hypertension such as variceal bleeding or refractory ascites who do not respond to
medical therapy. In current medical practice, 80 to 90% of TIPS procedures are performed
in an elective or semielective fashion and only a small percentage of cases are now
performed on an emergency basis. The experience gained has demonstrated that certain
patients do not benefit from a TIPS procedure and furthermore, their baseline condition
may even worsen after a TIPS. This article reviews the most important aspects of the
clinical evaluation of patients undergoing an elective TIPS procedure.
KEYWORDS
MELD score - portal hypertension - Child-Pugh score - transjugular intrahepatic portosystemic
shunts
REFERENCES
- 1
Richter G M, Noeldge G, Palmaz J C, Roessle M.
The transjugular intrahepatic portosystemic stent-shunt (TIPSS): results of a pilot
study.
Cardiovasc Intervent Radiol.
1990;
13
200-207
- 2
Zemel G, Katzen B T, Becker G J, Benenati J F, Sallee D S.
Percutaneous transjugular portosystemic shunt.
JAMA.
1991;
266
390-393
- 3
Helton W S, Belshaw A, Althaus S, Park S, Coldwell D, Johansen K.
Critical appraisal of the angiographic portacaval shunt (TIPS).
Am J Surg.
1993;
165
566-571
- 4
Freedman A M, Sanyal A J, Tisnado J et al..
Complications of transjugular intrahepatic portosystemic shunt: a comprehensive review.
Radiographics.
1993;
13
1185-1210
- 5
Shiffman M L, Jeffers L, Hoofnagle J H, Tralka T S.
The role of transjugular intrahepatic portosystemic shunt for treatment of portal
hypertension and its complications: a conference sponsored by the National Digestive
Diseases Advisory Board.
Hepatology.
1995;
22
1591-1597
- 6
Tyburski J G, Noorily M J, Wilson R F.
Prognostic factors with the use of the transjugular intrahepatic portosystemic shunt
for bleeding varices.
Arch Surg.
1997;
132
626-630
discussion 630-622
- 7
Sanyal A J, Genning C, Reddy K R et al..
The North American Study for the treatment of refractory ascites.
Gastroenterology.
2003;
124
634-641
- 8
Rosch J, Keller F S.
Transjugular intrahepatic portosystemic shunt: present status, comparison with endoscopic
therapy and shunt surgery, and future prospectives.
World J Surg.
2001;
25
337-345
discussion 345-336
- 9
Boyer T D, Haskal Z J.
The role of transjugular intrahepatic portosystemic shunt in the management of portal
hypertension.
Hepatology.
2005;
41
386-400
- 10
Patch D, Nikolopoulou V, McCormick A et al..
Factors related to early mortality after transjugular intrahepatic portosystemic shunt
for failed endoscopic therapy in acute variceal bleeding.
J Hepatol.
1998;
28
454-460
- 11
Malinchoc M, Kamath P S, Gordon F D, Peine C J, Rank J, ter Borg P C.
A model to predict poor survival in patients undergoing transjugular intrahepatic
portosystemic shunts.
Hepatology.
2000;
31
864-871
- 12
Bilbao J I, Pueyo J C, Longo J M et al..
Interventional therapeutic techniques in Budd-Chiari syndrome.
Cardiovasc Intervent Radiol.
1997;
20
112-119
- 13
Spencer E B, Cohen D T, Darcy M D.
Safety and efficacy of transjugular intrahepatic portosystemic shunt creation for
the treatment of hepatic hydrothorax.
J Vasc Interv Radiol.
2002;
13
385-390
- 14
Guevara M, Gines P, Bandi J C et al..
Transjugular intrahepatic portosystemic shunt in hepatorenal syndrome: effects on
renal function and vasoactive systems.
Hepatology.
1998;
28
416-422
- 15
Selim K M, Akriviadis E A, Zuckerman E, Chen D, Reynolds T B.
Transjugular intrahepatic portosystemic shunt: a successful treatment for hepatopulmonary
syndrome.
Am J Gastroenterol.
1998;
93
455-458
- 16
Haskal Z J, Scott M, Rubin R A, Cope C.
Intestinal varices: treatment with the transjugular intrahepatic portosystemic shunt.
Radiology.
1994;
191
183-187
- 17
Boyer T D.
Transjugular intrahepatic portosystemic shunt: current status.
Gastroenterology.
2003;
124
1700-1710
- 18
Ferral H, Patel N H.
Selection criteria for patients undergoing transjugular intrahepatic portosystemic
shunt procedures: current status.
J Vasc Interv Radiol.
2005;
16
449-455
- 19
Haskal Z J, Rees C R, Ring E J, Saxon R, Sacks D.
Reporting standards for transjugular intrahepatic portosystemic shunts. Technology
Assessment Committee of the SCVIR.
J Vasc Interv Radiol.
1997;
8
289-297
- 20
Pugh R N, Murray-Lyon I M, Dawson J L, Pietroni M C, Williams R.
Transection of the oesophagus for bleeding oesophageal varices.
Br J Surg.
1973;
60
646-649
- 21
Forman L M, Lucey M R.
Predicting the prognosis of chronic liver disease: an evolution from child to MELD.
Hepatology.
2001;
33
473-475
- 22
Schepke M, Roth F, Fimmers R 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
1167-1174
- 23
Angermayr B, Cejna M, Karnel F et al..
Child-Pugh versus MELD score in predicting survival in patients undergoing transjugular
intrahepatic portosystemic shunt.
Gut.
2003;
52
879-885
- 24
Encarnacion C E, Palmaz J C, Rivera F J et al..
Transjugular intrahepatic portosystemic shunt placement for variceal bleeding: predictors
of mortality.
J Vasc Interv Radiol.
1995;
6
687-694
- 25
Rubin R A, Haskal Z J, O'Brien C B, Cope C, Brass C A.
Transjugular intrahepatic portosystemic shunting: decreased survival for patients
with high APACHE II scores.
Am J Gastroenterol.
1995;
90
556-563
- 26
Banares R, Casado M, Rodriguez-Laiz J M et al..
Urgent transjugular intrahepatic portosystemic shunt for control of acute variceal
bleeding.
Am J Gastroenterol.
1998;
93
75-79
- 27
Salerno F, Merli M, Cazzaniga M et al..
MELD score is better than Child-Pugh score in predicting 3-month survival of patients
undergoing transjugular intrahepatic portosystemic shunt.
J Hepatol.
2002;
36
494-500
- 28
Ferral H, Vasan R, Speeg K V et al..
Evaluation of a model to predict poor survival in patients undergoing elective TIPS
procedures.
J Vasc Interv Radiol.
2002;
13
1103-1108
- 29
Kamath P S, Wiesner R H, Malinchoc M et al..
A model to predict survival in patients with end-stage liver disease [see comments].
Hepatology.
2001;
33
464-470
- 30
Wiesner R H, McDiarmid S V, Kamath P S et al..
MELD and PELD: application of survival models to liver allocation.
Liver Transpl.
2001;
7
567-580
- 31
Said A, Williams J, Holden J et al..
Model for end stage liver disease score predicts mortality across a broad spectrum
of liver disease.
J Hepatol.
2004;
40
897-903
- 32
Ferral H, Gamboa P, Postoak D W et al..
Survival after elective transjugular intrahepatic portosystemic shunt creation: prediction
with model for end-stage liver disease score.
Radiology.
2004;
231
231-236
Hector FerralM.D.
Department of Radiology, Rush University Medical Center
1653 West Congress Parkway, Chicago, IL 60612
