Transjugular intrahepatic portosystemic stent-shunt: technical factors and new developments.

Abstract:

:The introduction of expandable metal stents in the mid 1980s led to the development of transjugular intrahepatic portosystemic stent-shunt (TIPSS) as we know it today. Short-lived detrimental effects on the hyperdynamic circulation in cirrhosis accompany the acute reduction in portal pressure following TIPSS creation. Caution is needed in patients with cardiac dysfunction or pulmonary hypertension. With increasing expertise and careful patient selection, fatal procedural complications are rare and TIPSS can even be safely used as a bridge to liver transplantation. Shunt insufficiency and hepatic encephalopathy are more common following TIPSS. Currently, however, novel approaches to tackling both these limitations exist. These include the combination of uncovered TIPSS with variceal band ligation, and the introduction of polytetrafluoroethylene covered stents. Despite the lack of controlled studies, covered stents are now widely used and have the potential to drastically reduce shunt insufficiency, the need for long-term shunt surveillance and even hepatic encephalopathy.

authors

Tripathi D,Redhead D

doi

10.1097/01.meg.0000236871.78280.a7

subject

Has Abstract

pub_date

2006-11-01 00:00:00

pages

1127-33

issue

11

eissn

0954-691X

issn

1473-5687

pii

00042737-200611000-00002

journal_volume

18

pub_type

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