Transjugular intrahepatic portosystemic shunts (TIPSS): The Aintree experience

Author(s): Dr B L Jones, Dr J Ghany, Dr I U Din, Dr J Tuson, Dr P Kumar

Hospital: University Hospital Aintree

Reference: RAD Magazine, 40, 473, 26-28

Excerpt: 

In 1982, Colapinto first introduced the transjugular intrahepatic portosystemic shunt (TIPSS) procedure into clinical medicine. TIPSS is a minimally invasive procedure where an artificial channel is created between the portal vein and hepatic vein inside the liver. The aim of the procedure is to bypass a high resistance liver bed in an effort to eliminate portal hypertension. Portal hypertension, a universal consequence of cirrhosis, eventually leads to complications such as variceal bleeding, ascites and the hepatorenal syndrome. The onset of these symptoms indicates transition from the stage of compensated liver disease to a decompensated state. Approximately 5-7% of patients with cirrhosis advance to this decompensated stage every year. This results in a reduction in median survival from 12 years to just two years.

TIPSS is performed most commonly for patients with variceal bleeding unresponsive to optimal medical and endoscopic therapy, and refractory ascites. Refractory ascites is defined by its unresponsiveness to diuretics. Once ascites becomes refractory to diuretics, 50% of patients die within one year.

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