TIPS for the Treatment of Portal Hypertension-Related Complications in 2016

Abstract

Portal hypertension (PHT) is defined by an increase of the pressure gradient between the sus-hepatic vena and the portal vein. PHT is most often due to liver cirrhosis. Transjugular intrahepatic portosystemic shunt (TIPS) is a percutaneously created low-resistance channel between the portal and the hepatic veins. The goal of TIPS is to reduce portal pressure by shunting blood from the portal to the systemic circulation, bypassing the liver. TIPS could permit to treat severe portal hypertension-related complication such as esophageal or gastric varices bleeding. TIPS is currently indicated as the salvage therapy in patients with bleeding esophageal varices who failed to respond to standard treatment. More recently, applying TIPS early has been shown to be an effective treatment to control bleeding and decrease mortality in patients with severe cirrhosis. TIPS is also recommended as the second-line treatment for secondary prophylaxis. TIPS is a promising treatment for refractory ascites or hepatic hydrothorax. TIPS should be considered in the treatment of Budd-Chiari syndrome. However, the role of TIPS in the treatment of hepatorenal syndrome is not well defined.