Transjugular intrahepatic portosystemic shunt - Revision history

Danbot: Add peer-reviewed references with PMIDs

2026-03-22T09:58:27Z

Add peer-reviewed references with PMIDs

← Older revision		Revision as of 09:58, 22 March 2026
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	*Portal venous hypertension		*Portal venous hypertension
	*Refractory variceal bleeding after endoscopic (sclerotherapy or band ligation) and pharmacologic (octreotide or vasopressin) therapy		*Refractory variceal bleeding after endoscopic (sclerotherapy or band ligation) and pharmacologic (octreotide or vasopressin) therapy<ref>Garcia-Tsao G, et al. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology. 2007;46(3):922-938. PMID 17879356</ref>
	*Recurrent cirrhotic [[Special:MyLanguage/ascites\|ascites]] that is not responsive to medical treatment and requires frequent large volume paracentesis		*Recurrent cirrhotic [[Special:MyLanguage/ascites\|ascites]] that is not responsive to medical treatment and requires frequent large volume paracentesis
	*Controversial indications include Budd-Chiari Syndrome, [[Special:MyLanguage/hepatorenal syndrome\|hepatorenal syndrome]], hepatic hydrothorax, hepatopulmonary syndrome and bridge therapy while awaiting liver transplantation		*Controversial indications include Budd-Chiari Syndrome, [[Special:MyLanguage/hepatorenal syndrome\|hepatorenal syndrome]], hepatic hydrothorax, hepatopulmonary syndrome and bridge therapy while awaiting liver transplantation

Ostermayer: Prepared the page for translation

2026-01-05T00:01:15Z

Prepared the page for translation

← Older revision		Revision as of 00:01, 5 January 2026
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			<languages/>
			<translate>

	==Background==		==Background==

	*Mnimally invasive procedure performed by IR		*Mnimally invasive procedure performed by IR
	*Creation of a stent connection between the right hepatic vein and portal vein		*Creation of a stent connection between the right hepatic vein and portal vein
	*Shunts blood flow from the portal venous system to systemic circulation		*Shunts blood flow from the portal venous system to systemic circulation
	*Decreases portal venous pressure to <12 mmHg		*Decreases portal venous pressure to <12 mmHg


	==Indications==		==Indications==

	*Portal venous hypertension		*Portal venous hypertension
	*Refractory variceal bleeding after endoscopic (sclerotherapy or band ligation) and pharmacologic (octreotide or vasopressin) therapy		*Refractory variceal bleeding after endoscopic (sclerotherapy or band ligation) and pharmacologic (octreotide or vasopressin) therapy
	*Recurrent cirrhotic [[ascites]] that is not responsive to medical treatment and requires frequent large volume paracentesis		*Recurrent cirrhotic [[Special:MyLanguage/ascites\|ascites]] that is not responsive to medical treatment and requires frequent large volume paracentesis
	*Controversial indications include Budd-Chiari Syndrome, [[hepatorenal syndrome]], hepatic hydrothorax, hepatopulmonary syndrome and bridge therapy while awaiting liver transplantation		*Controversial indications include Budd-Chiari Syndrome, [[Special:MyLanguage/hepatorenal syndrome\|hepatorenal syndrome]], hepatic hydrothorax, hepatopulmonary syndrome and bridge therapy while awaiting liver transplantation


	==Contraindications==		==Contraindications==
	*[[Congestive heart failure]]
			*[[Special:MyLanguage/Congestive heart failure\|Congestive heart failure]]
	*Tricuspid valve regurgitation		*Tricuspid valve regurgitation
	*[[Pulmonary hypertension]]		*[[Special:MyLanguage/Pulmonary hypertension\|Pulmonary hypertension]]
	*[[Sepsis]]		*[[Special:MyLanguage/Sepsis\|Sepsis]]
	*Hepatic malignancy, large masses or cysts		*Hepatic malignancy, large masses or cysts
	*Severe coagulopathy		*Severe coagulopathy
	*Biliary obstruction		*Biliary obstruction


	==Complications==		==Complications==

	*Portosystemic encephalopathy		*Portosystemic encephalopathy
	**Most common complication		**Most common complication
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	**Stent may travel into the Inferior Vena Cava		**Stent may travel into the Inferior Vena Cava
	**Most serious complication is migration into the heart		**Most serious complication is migration into the heart
	**[[ECG]], Doppler sonography, and echocardiogram helpful for diagnosis		**[[Special:MyLanguage/ECG\|ECG]], Doppler sonography, and echocardiogram helpful for diagnosis
	**Treatment is surgery or Interventional Radiology for retrieval		**Treatment is surgery or Interventional Radiology for retrieval


	==Outcomes==		==Outcomes==

	*TIPS provides salvage therapy for variceal bleeding, refractory ascites, and portal hypertension when medical therapy fails		*TIPS provides salvage therapy for variceal bleeding, refractory ascites, and portal hypertension when medical therapy fails
	*Despite providing improvement in portal hypertension, the procedure does not decrease overall mortality in end stage liver disease		*Despite providing improvement in portal hypertension, the procedure does not decrease overall mortality in end stage liver disease


	==References==		==References==

	*Boyer TD, Haskal ZJ. American Association for the Study of Liver Diseases. The Role of Transjugular Intrahepatic Portosystemic Shunt (TIPS) in the Management of Portal Hypertension: update 2009. Hepatology. 2010;51(1:1-16).		*Boyer TD, Haskal ZJ. American Association for the Study of Liver Diseases. The Role of Transjugular Intrahepatic Portosystemic Shunt (TIPS) in the Management of Portal Hypertension: update 2009. Hepatology. 2010;51(1:1-16).
	*Subramanian R, McCashland T. Chapter 82. Gastrointestinal Hemorrhage. In: Hall JB, Schmidt GA, Wood LH. eds. Principles of Critical Care, 3e. New York, NY: McGraw-Hill; 2005.		*Subramanian R, McCashland T. Chapter 82. Gastrointestinal Hemorrhage. In: Hall JB, Schmidt GA, Wood LH. eds. Principles of Critical Care, 3e. New York, NY: McGraw-Hill; 2005.
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	[[Category:GI]]		[[Category:GI]]
			</translate>

Rossdonaldson1: Text replacement - "ECG" to "ECG"

2016-09-09T16:06:47Z

Text replacement - "*ECG" to "*ECG"

← Older revision		Revision as of 16:06, 9 September 2016
Line 59:		Line 59:
	**Stent may travel into the Inferior Vena Cava		**Stent may travel into the Inferior Vena Cava
	**Most serious complication is migration into the heart		**Most serious complication is migration into the heart
	**ECG, Doppler sonography, and echocardiogram helpful for diagnosis		**[[ECG]], Doppler sonography, and echocardiogram helpful for diagnosis
	**Treatment is surgery or Interventional Radiology for retrieval		**Treatment is surgery or Interventional Radiology for retrieval

Neil.m.young: Text replacement - "doppler" to "Doppler"

2016-08-15T12:53:07Z

Text replacement - "doppler" to "Doppler"

← Older revision		Revision as of 12:53, 15 August 2016
Line 59:		Line 59:
	**Stent may travel into the Inferior Vena Cava		**Stent may travel into the Inferior Vena Cava
	**Most serious complication is migration into the heart		**Most serious complication is migration into the heart
	**ECG, ~~doppler~~ sonography, and echocardiogram helpful for diagnosis		**ECG, Doppler sonography, and echocardiogram helpful for diagnosis
	**Treatment is surgery or Interventional Radiology for retrieval		**Treatment is surgery or Interventional Radiology for retrieval

ClaireLewis: /* Indications */

2016-07-13T22:50:09Z

Indications

← Older revision		Revision as of 22:50, 13 July 2016
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	*Portal venous hypertension		*Portal venous hypertension
	*Refractory variceal bleeding after endoscopic (sclerotherapy or band ligation) and pharmacologic (octreotide or vasopressin) therapy		*Refractory variceal bleeding after endoscopic (sclerotherapy or band ligation) and pharmacologic (octreotide or vasopressin) therapy
	*Recurrent cirrhotic ascites that is not responsive to medical treatment and requires frequent large volume paracentesis		*Recurrent cirrhotic [[ascites]] that is not responsive to medical treatment and requires frequent large volume paracentesis
	*Controversial indications include Budd-Chiari Syndrome, hepatorenal syndrome, hepatic hydrothorax, hepatopulmonary syndrome and bridge therapy while awaiting liver transplantation		*Controversial indications include Budd-Chiari Syndrome, [[hepatorenal syndrome]], hepatic hydrothorax, hepatopulmonary syndrome and bridge therapy while awaiting liver transplantation

	==Contraindications==		==Contraindications==

Ostermayer: Text replacement - "EKG" to "ECG"

2016-05-19T17:18:14Z

Text replacement - "EKG" to "ECG"

← Older revision		Revision as of 17:18, 19 May 2016
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	**Stent may travel into the Inferior Vena Cava		**Stent may travel into the Inferior Vena Cava
	**Most serious complication is migration into the heart		**Most serious complication is migration into the heart
	**~~EKG~~, doppler sonography, and echocardiogram helpful for diagnosis		**ECG, doppler sonography, and echocardiogram helpful for diagnosis
	**Treatment is surgery or Interventional Radiology for retrieval		**Treatment is surgery or Interventional Radiology for retrieval

Rossdonaldson1: /* References */

2015-03-24T20:00:08Z

References

← Older revision		Revision as of 20:00, 24 March 2015
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	*Subramanian R, McCashland T. Chapter 82. Gastrointestinal Hemorrhage. In: Hall JB, Schmidt GA, Wood LH. eds. Principles of Critical Care, 3e. New York, NY: McGraw-Hill; 2005.		*Subramanian R, McCashland T. Chapter 82. Gastrointestinal Hemorrhage. In: Hall JB, Schmidt GA, Wood LH. eds. Principles of Critical Care, 3e. New York, NY: McGraw-Hill; 2005.
	*Wendler C, Shoenberger JM, Mailhot T. Transjugular Intrahepatic Portosystemic Shunt (TIPS) Migration to the Heart Diagnosed by Emergency Department Ultrasound. West J Emerg Med. 2012;13(6:525-6).		*Wendler C, Shoenberger JM, Mailhot T. Transjugular Intrahepatic Portosystemic Shunt (TIPS) Migration to the Heart Diagnosed by Emergency Department Ultrasound. West J Emerg Med. 2012;13(6:525-6).

			[[Category:GI]]

Drkaywarren: ref

2015-03-23T00:22:56Z

ref

← Older revision		Revision as of 00:22, 23 March 2015
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	==References==		==References==
	*Boyer TD, Haskal ZJ. American Association for the Study of Liver Diseases. The Role of Transjugular Intrahepatic Portosystemic Shunt (TIPS) in the Management of Portal Hypertension: update 2009. Hepatology. 2010;51(1):1-16.		*Boyer TD, Haskal ZJ. American Association for the Study of Liver Diseases. The Role of Transjugular Intrahepatic Portosystemic Shunt (TIPS) in the Management of Portal Hypertension: update 2009. Hepatology. 2010;51(1:1-16).
	*Subramanian R, McCashland T. Chapter 82. Gastrointestinal Hemorrhage. In: Hall JB, Schmidt GA, Wood LH. eds. Principles of Critical Care, 3e. New York, NY: McGraw-Hill; 2005.		*Subramanian R, McCashland T. Chapter 82. Gastrointestinal Hemorrhage. In: Hall JB, Schmidt GA, Wood LH. eds. Principles of Critical Care, 3e. New York, NY: McGraw-Hill; 2005.
	*Wendler C, Shoenberger JM, Mailhot T. Transjugular Intrahepatic Portosystemic Shunt (TIPS) Migration to the Heart Diagnosed by Emergency Department Ultrasound. West J Emerg Med. 2012;13(6):525-6.		*Wendler C, Shoenberger JM, Mailhot T. Transjugular Intrahepatic Portosystemic Shunt (TIPS) Migration to the Heart Diagnosed by Emergency Department Ultrasound. West J Emerg Med. 2012;13(6:525-6).

Arsmd at 11:07, 22 March 2015

2015-03-22T11:07:11Z

← Older revision		Revision as of 11:07, 22 March 2015
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	==~~'''~~Background~~'''~~==		==Background==
	*~~TIPS is a minimally~~ invasive procedure ~~that is~~ performed by ~~Interventional Radiology~~		*Mnimally invasive procedure performed by IR
	*~~Involves the creation~~ of a stent connection between the right hepatic vein and portal vein		*Creation of a stent connection between the right hepatic vein and portal vein
	*~~Results in shunting of~~ blood flow from the portal venous system to systemic circulation		*Shunts blood flow from the portal venous system to systemic circulation
	*Decreases portal venous pressure to < 12 ~~mm Hg~~		*Decreases portal venous pressure to <12 mmHg

	==~~'''~~Indications~~'''~~==		==Indications==
	*Portal venous hypertension		*Portal venous hypertension
	*Refractory variceal bleeding after endoscopic (sclerotherapy or band ligation) and pharmacologic (octreotide or vasopressin) therapy		*Refractory variceal bleeding after endoscopic (sclerotherapy or band ligation) and pharmacologic (octreotide or vasopressin) therapy
Line 11:		Line 11:
	*Controversial indications include Budd-Chiari Syndrome, hepatorenal syndrome, hepatic hydrothorax, hepatopulmonary syndrome and bridge therapy while awaiting liver transplantation		*Controversial indications include Budd-Chiari Syndrome, hepatorenal syndrome, hepatic hydrothorax, hepatopulmonary syndrome and bridge therapy while awaiting liver transplantation

	==~~'''~~Contraindications~~'''~~==		==Contraindications==
	*Congestive heart failure		*[[Congestive heart failure]]
	*Tricuspid valve regurgitation		*Tricuspid valve regurgitation
	*Pulmonary hypertension		*[[Pulmonary hypertension]]
	*Sepsis		*[[Sepsis]]
	*Hepatic malignancy, large masses or cysts		*Hepatic malignancy, large masses or cysts
	*Severe coagulopathy		*Severe coagulopathy
	*Biliary obstruction		*Biliary obstruction

	==~~'''~~Complications~~'''~~==		==Complications==
	*Portosystemic encephalopathy		*Portosystemic encephalopathy
	**Most common complication		**Most common complication
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	*TIPS thrombosis		*TIPS thrombosis
	**~~Occurs approximately~~ 4 weeks after TIPS		**~4 weeks after TIPS
	**Doppler sonography or angiography shows thrombus and/or occlusion		**Doppler sonography or angiography shows thrombus and/or occlusion
	**Treatment ~~includes~~ anticoagulation, thrombolysis, or thrombectomy		**Treatment: anticoagulation, thrombolysis, or thrombectomy

	*TIPS stenosis		*TIPS stenosis
	**May present with recurrent variceal bleeding or worsening portal hypertension		**May present with recurrent variceal bleeding or worsening portal hypertension
	**~~Occurs approximately~~ 3 months to 2 years after TIPS		**~3 months to 2 years after TIPS
	**Angiography is the gold standard for diagnosis		**Angiography is the gold standard for diagnosis
	**Treatment is dilation or placement of new or additional stents		**Treatment is dilation or placement of new or additional stents
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	*TIPS-associated hemolysis		*TIPS-associated hemolysis
	**Presentation includes anemia, increased bilirubin, and increased reticulocyte count		**Presentation includes anemia, increased bilirubin, and increased reticulocyte count
	**~~Occurs within~~ 1-2 weeks after TIPS		**<1-2 weeks after TIPS
	**Self-limiting and resolves within 8-12 weeks		**Self-limiting and resolves within 8-12 weeks

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	**Treatment is surgery or Interventional Radiology for retrieval		**Treatment is surgery or Interventional Radiology for retrieval

	==~~'''~~Outcomes~~'''~~==		==Outcomes==
	*TIPS provides salvage therapy for variceal bleeding, refractory ascites, and portal hypertension when medical therapy fails		*TIPS provides salvage therapy for variceal bleeding, refractory ascites, and portal hypertension when medical therapy fails
	*Despite providing improvement in portal hypertension, the procedure does not decrease overall mortality in end stage liver disease		*Despite providing improvement in portal hypertension, the procedure does not decrease overall mortality in end stage liver disease

	==~~'''~~References~~'''~~==		==References==
	*Boyer TD, Haskal ZJ. American Association for the Study of Liver Diseases. The Role of Transjugular Intrahepatic Portosystemic Shunt (TIPS) in the Management of Portal Hypertension: update 2009. Hepatology. 2010;51(1):1-16.		*Boyer TD, Haskal ZJ. American Association for the Study of Liver Diseases. The Role of Transjugular Intrahepatic Portosystemic Shunt (TIPS) in the Management of Portal Hypertension: update 2009. Hepatology. 2010;51(1):1-16.
	*Subramanian R, McCashland T. Chapter 82. Gastrointestinal Hemorrhage. In: Hall JB, Schmidt GA, Wood LH. eds. Principles of Critical Care, 3e. New York, NY: McGraw-Hill; 2005.		*Subramanian R, McCashland T. Chapter 82. Gastrointestinal Hemorrhage. In: Hall JB, Schmidt GA, Wood LH. eds. Principles of Critical Care, 3e. New York, NY: McGraw-Hill; 2005.
	*Wendler C, Shoenberger JM, Mailhot T. Transjugular Intrahepatic Portosystemic Shunt (TIPS) Migration to the Heart Diagnosed by Emergency Department Ultrasound. West J Emerg Med. 2012;13(6):525-6.		*Wendler C, Shoenberger JM, Mailhot T. Transjugular Intrahepatic Portosystemic Shunt (TIPS) Migration to the Heart Diagnosed by Emergency Department Ultrasound. West J Emerg Med. 2012;13(6):525-6.

	~~Authors~~
	~~Denise McCormack, Karma Warren~~

Mccormack5681 at 21:18, 17 March 2015

2015-03-17T21:18:21Z

← Older revision		Revision as of 21:18, 17 March 2015
Line 1:		Line 1:
	==Background==		=='''Background'''==
	*TIPS is a minimally invasive procedure that is performed by Interventional Radiology		*TIPS is a minimally invasive procedure that is performed by Interventional Radiology
	*Involves the creation of a stent connection between the right hepatic vein and portal vein		*Involves the creation of a stent connection between the right hepatic vein and portal vein
Line 5:		Line 5:
	*Decreases portal venous pressure to < 12 mm Hg		*Decreases portal venous pressure to < 12 mm Hg

	==Indications==		=='''Indications'''==
	*Portal venous hypertension		*Portal venous hypertension
	*Refractory variceal bleeding after endoscopic (sclerotherapy or band ligation) and pharmacologic (octreotide or vasopressin) therapy		*Refractory variceal bleeding after endoscopic (sclerotherapy or band ligation) and pharmacologic (octreotide or vasopressin) therapy
Line 11:		Line 11:
	*Controversial indications include Budd-Chiari Syndrome, hepatorenal syndrome, hepatic hydrothorax, hepatopulmonary syndrome and bridge therapy while awaiting liver transplantation		*Controversial indications include Budd-Chiari Syndrome, hepatorenal syndrome, hepatic hydrothorax, hepatopulmonary syndrome and bridge therapy while awaiting liver transplantation

	==Contraindications==		=='''Contraindications'''==
	*Congestive heart failure		*Congestive heart failure
	*Tricuspid valve regurgitation		*Tricuspid valve regurgitation
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	*Biliary obstruction		*Biliary obstruction

	==Complications==		=='''Complications'''==
	*Portosystemic encephalopathy		*Portosystemic encephalopathy
	**Most common complication		**Most common complication
Line 62:		Line 62:
	**Treatment is surgery or Interventional Radiology for retrieval		**Treatment is surgery or Interventional Radiology for retrieval

	==Outcomes==		=='''Outcomes'''==
	*TIPS provides salvage therapy for variceal bleeding, refractory ascites, and portal hypertension when medical therapy fails		*TIPS provides salvage therapy for variceal bleeding, refractory ascites, and portal hypertension when medical therapy fails
	*Despite providing improvement in portal hypertension, the procedure does not decrease overall mortality in end stage liver disease		*Despite providing improvement in portal hypertension, the procedure does not decrease overall mortality in end stage liver disease

	==References==		=='''References'''==
	*Boyer TD, Haskal ZJ. American Association for the Study of Liver Diseases. The Role of Transjugular Intrahepatic Portosystemic Shunt (TIPS) in the Management of Portal Hypertension: update 2009. Hepatology. 2010;51(1):1-16.		*Boyer TD, Haskal ZJ. American Association for the Study of Liver Diseases. The Role of Transjugular Intrahepatic Portosystemic Shunt (TIPS) in the Management of Portal Hypertension: update 2009. Hepatology. 2010;51(1):1-16.
	*Subramanian R, McCashland T. Chapter 82. Gastrointestinal Hemorrhage. In: Hall JB, Schmidt GA, Wood LH. eds. Principles of Critical Care, 3e. New York, NY: McGraw-Hill; 2005.		*Subramanian R, McCashland T. Chapter 82. Gastrointestinal Hemorrhage. In: Hall JB, Schmidt GA, Wood LH. eds. Principles of Critical Care, 3e. New York, NY: McGraw-Hill; 2005.
	*Wendler C, Shoenberger JM, Mailhot T. Transjugular Intrahepatic Portosystemic Shunt (TIPS) Migration to the Heart Diagnosed by Emergency Department Ultrasound. West J Emerg Med. 2012;13(6):525-6.		*Wendler C, Shoenberger JM, Mailhot T. Transjugular Intrahepatic Portosystemic Shunt (TIPS) Migration to the Heart Diagnosed by Emergency Department Ultrasound. West J Emerg Med. 2012;13(6):525-6.

			Authors
			Denise McCormack, Karma Warren