Abstract
The origins of transjugular intrahepatic portosystemic shunt (TIPS) date back to the
1960s with inadvertent portal access during the early years of transjugular cholangiography.
TIPS is now the most frequently performed portal hypertension decompressive procedure
performed by interventional radiologists, and has become the primary portosystemic
shunt (surgical or percutaneous) performed in the United States. One of the least
discussed major advantages of TIPS in the transplant era is that it is intrahepatic
and thus is removed in situ during a liver transplant, while extrahepatic shunts (surgical
or percutaneous) have to be ligated or revised during the liver transplantation. However,
since the widespread clinical utilization of TIPS in the 1990s, it has been plagued
with two major problems, namely, patency and hepatic encephalopathy. With the advent
of commercially available expanded polytetraflouroethylenne (e-PTFE) covered stents
a decade ago, 12- to 24-month TIPS patency has improved significantly (by ∼20–30%).
However, hepatic encephalopathy (although not proven to have increased due to e-PTFE
covered stents grafts) remains a significant morbidity problem. The article discusses
the history of TIPS, critiques the retrospective encephalopathy data in the literature,
and discusses futuristic TIPS-design ideas about the management of post-TIPS hepatic
encephalopathy.
Keywords
TIPS - history - portosystemic shunt - portal hypertension - development - interventional
radiology
