Abstract
Does transjugular intrahepatic portosystemic shunt stent (TIPS) improve survival in
a subgroup of patients? Yes. TIPS nearly halves portal pressure and increases the
effective blood volume. In cases of acute variceal hemorrhage and with a high risk
of treatment failure, defined as either hepatic venous pressure gradient higher than
20 mm Hg, Child B with active bleeding at the endoscopy, or Child C with less than
14 points, early or preemptive placement of TIPS (within 72 hours) improves survival.
Also, in suitable patients with intractable or refractory ascites, TIPS improves survival
if placed early in the course of treatment. While TIPS does not improve survival in
other situations, it improves disease management, especially in patients without TIPS
contraindications but with refractory bleeding, early rebleeding, portal vein thrombosis,
and hepatorenal syndrome. Experience gained at the centers and follow-up of TIPS patients
are key features that improve outcome. Important factors for selection and follow-up
include cardiac function, inflammation, sarcopenia, age, and early evaluation for
liver transplantation.
Keywords
variceal bleeding - refractory ascites - portal hypertension - systemic inflammation
- sarcopenia
