Are TIPS Tops in the Treatment of Portal Hypertension? A Review on the Use and Misuse of Transjugular Intrahepatic Portosystemic Shunts

Complications of portal hypertension are the Achilles heel of end-stage liver disease. Although initially developed in the 1960s, transjugular intrahepatic portosystemic shunts (TIPS) have recently gained popularity for decompressing the portal vein in patients with portal hypertension. The main indications for TIPS are the treatment of variceal hemorrhage unresponsive to endoscopic treatment and refractory ascites. Although several other applications for TIPS have been reported, they have not been tested in controlled trials. TIPS are not appropriate as initial therapy for variceal hemorrhage and ascites. Due to the virtually universal development of TIPS stenosis in the majority of patients, careful monitoring of stent patency is required. Several complications of TIPS are recognized, some of which are potentially fatal. Consequently, careful patient selection for TIPS is of paramount importance. Until further clinical trials become available, TIPS should be considered as a therapeutic option for the treatment of refractory variceal hemorrhage and refractory ascites in selected patients