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
✍ Scribed by Mitchell L. Shiffman; Lennox Jeffers; Jay H. Hoofnagle; Tommie Sue Tralka
- Publisher
- John Wiley and Sons
- Year
- 1995
- Tongue
- English
- Weight
- 939 KB
- Volume
- 22
- Category
- Article
- ISSN
- 0270-9139
No coin nor oath required. For personal study only.
✦ Synopsis
Transjugular intrahepatic portosystemic shunting (TIPS) is a recently developed radiological procedure that involves the creation of a parenchymal tract between the portal and hepatic veins followed by reinforcement of the tract with a metallic stent. The technical feasibility for this procedure was initially shown by Gutierrez et a1 in dogs in which a prosthetic stent was used to bridge the portal and hepatic veins.' This was soon followed by reports from Colapinto et aI2 and Gordon et a13 that intrahepatic parenchymal tracts between hepatic and portal veins could be successfully created in humans. In the 1980s metalic stents and special catheter systems necessary for their deployment were developed and used by Palmaz et a14 and Rosch et, al.536 These steps pioneered the present era and widespread acceptance of TIPS as a therapeutic tool for treatment of portal hypertension and its compli-cation~.~.'~ TIPS can now be performed in an angiography suite by experienced operators within 30 to 120 minutes using conscious sedation. This procedure is unquestionably effective in decreasing portal pressure, functioning in much the same manner as a surgically created side-to-side portocaval shunt. Two large series have recently been published that describe the use of TIPS in patients with bleeding esophageal and gastric varices who were refractory to conventional medical treatment including sclerotherapy.lO,ll These studies documented that TIPS can achieve immediate control of variceal hemorrhage with minimal complications. These reports have led to the widespread use of TIPS in both academic and community medical centers.