Download PDF
Semin intervent Radiol 2023; 40(01): 044-054
DOI: 10.1055/s-0043-1764410
Review Article

Transjugular Intrahepatic Portosystemic Shunt Reductions

Arthur Joseph
1   Department of Radiology, UT Health San Antonio, San Antonio, Texas
,
Jorge Lopera
1   Department of Radiology, UT Health San Antonio, San Antonio, Texas
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Transjugular intrahepatic portosystemic shunts (TIPS) are effective in reducing the portosystemic gradient and relieving complications of portal hypertension. Despite optimal patient selection, TIPS placement can be limited due to worsening hepatic encephalopathy and liver failure. In these cases, TIPS reduction may be necessary. A brief history of TIPS reduction and techniques for reduction are reviewed.

Keywords

interventional radiology - transjugular intrahepatic portosystemic shunt - portal hypertension - complication - hepatic encephalopathy


Publication History

Article published online:
04 May 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Moon AM, Singal AG, Tapper EB. Contemporary epidemiology of chronic liver disease and cirrhosis. Clin Gastroenterol Hepatol 2020; 18 (12) 2650-2666
    CrossrefPubMedGoogle Scholar
  • 2 Biggins SW, Angeli P, Garcia-Tsao G. et al. Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 practice guidance by the American Association for the Study of Liver Diseases. Hepatology 2021; 74 (02) 1014-1048
    CrossrefPubMedGoogle Scholar
  • 3 Lindsay AJ, Burton J, Ray Jr CE. Paracentesis-induced circulatory dysfunction: a primer for the interventional radiologist. Semin Intervent Radiol 2014; 31 (03) 276-278 ). Thieme Medical Publishers.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Bai M, Qi XS, Yang ZP, Yang M, Fan DM, Han GH. TIPS improves liver transplantation-free survival in cirrhotic patients with refractory ascites: an updated meta-analysis. World J Gastroenterol 2014; 20 (10) 2704-2714
    CrossrefPubMedGoogle Scholar
  • 5 Narahara Y, Kanazawa H, Fukuda T. et al. Transjugular intrahepatic portosystemic shunt versus paracentesis plus albumin in patients with refractory ascites who have good hepatic and renal function: a prospective randomized trial. J Gastroenterol 2011; 46 (01) 78-85
    CrossrefPubMedGoogle Scholar
  • 6 Boregowda U, Umapathy C, Halim N. et al. Update on the management of gastrointestinal varices. World J Gastrointest Pharmacol Ther 2019; 10 (01) 1-21
    CrossrefPubMedGoogle Scholar
  • 7 Bochnakova T. Hepatic venous pressure gradient. Clin Liver Dis (Hoboken) 2021; 17 (03) 144-148
    CrossrefPubMedGoogle Scholar
  • 8 Bercu ZL, Fischman AM, Kim E. et al. TIPS for refractory ascites: a 6-year single-center experience with expanded polytetrafluoroethylene-covered stent-grafts. AJR Am J Roentgenol 2015; 204 (03) 654-661
    CrossrefPubMedGoogle Scholar
  • 9 Joseph AS, Sandhu B, Khalil A, Lopera J. Transjugular portosystemic shunt reductions: a retrospective single-center experience. J Vasc Interv Radiol 2019; 30 (06) 876-884
    CrossrefPubMedGoogle Scholar
  • 10 Suhocki PV, Lungren MP, Kapoor B, Kim CY. Transjugular intrahepatic portosystemic shunt complications: prevention and management. Semin Intervent Radiol 2015; 32 (02) 123-132 . Thieme Medical Publishers.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Schindler P, Heinzow H, Trebicka J, Wildgruber M. Shunt-induced hepatic encephalopathy in TIPS: current approaches and clinical challenges. J Clin Med 2020; 9 (11) 3784
    CrossrefPubMedGoogle Scholar
  • 12 Modha K, Kapoor B, Lopez R, Sands MJ, Carey W. Symptomatic heart failure after transjugular intrahepatic portosystemic shunt placement: incidence, outcomes, and predictors. Cardiovasc Intervent Radiol 2018; 41 (04) 564-571
    CrossrefPubMedGoogle Scholar
  • 13 Billey C, Billet S, Robic MA. et al. A prospective study identifying predictive factors of cardiac decompensation after transjugular intrahepatic portosystemic shunt: the Toulouse algorithm. Hepatology 2019; 70 (06) 1928-1941
    CrossrefPubMedGoogle Scholar
  • 14 Taylor AG, Kolli KP, Kerlan Jr RK. Techniques for transjugular intrahepatic portosystemic shunt reduction and occlusion. Tech Vasc Interv Radiol 2016; 19 (01) 74-81
    CrossrefPubMedGoogle Scholar
  • 15 Paz-Fumagalli R, Crain MR, Mewissen MW, Varma RR. Fatal hemodynamic consequences of therapeutic closure of a transjugular intrahepatic portosystemic shunt. J Vasc Interv Radiol 1994; 5 (06) 831-834
    CrossrefPubMedGoogle Scholar
  • 16 Kochar N, Tripathi D, Ireland H, Redhead DN, Hayes PC. Transjugular intrahepatic portosystemic stent shunt (TIPSS) modification in the management of post-TIPSS refractory hepatic encephalopathy. Gut 2006; 55 (11) 1617-1623
    CrossrefPubMedGoogle Scholar
  • 17 Pattynama PM, Wils A, van der Linden E, van Dijk LC. Embolization with the Amplatzer Vascular Plug in TIPS patients. Cardiovasc Intervent Radiol 2007; 30 (06) 1218-1221
    CrossrefPubMedGoogle Scholar
  • 18 Saad WEA. Portal Hypertension: Imaging, Diagnosis, and Endovascular Management. Thieme Medical Publishers; 2017
    Google Scholar
  • 19 Haskal ZJ, Middlebrook MR. Creation of a stenotic stent to reduce flow through a transjugular intrahepatic portosystemic shunt. J Vasc Interv Radiol 1994; 5 (06) 827-829 , discussion 829–830
    CrossrefPubMedGoogle Scholar
  • 20 Hauenstein KH, Haag K, Ochs A, Langer M, Rössle M. The reducing stent: treatment for transjugular intrahepatic portosystemic shunt-induced refractory hepatic encephalopathy and liver failure. Radiology 1995; 194 (01) 175-179
    CrossrefPubMedGoogle Scholar
  • 21 Forauer AR, McLean GK. Transjugular intrahepatic portosystemic shunt constraining stent for the treatment of refractory postprocedural encephalopathy: a simple design utilizing a Palmaz stent and Wallstent. J Vasc Interv Radiol 1998; 9 (03) 443-446
    CrossrefPubMedGoogle Scholar
  • 22 Saket RR, Sze DY, Razavi MK. et al. TIPS reduction with use of stents or stent-grafts. J Vasc Interv Radiol 2004; 15 (07) 745-751
    CrossrefPubMedGoogle Scholar
  • 23 Quaretti P, Michieletti E, Rossi S. Successful treatment of TIPS-induced hepatic failure with an hourglass stent-graft: a simple new technique for reducing shunt flow. J Vasc Interv Radiol 2001; 12 (07) 887-890
    CrossrefPubMedGoogle Scholar
  • 24 Fanelli F, Salvatori FM, Rabuffi P. et al. Management of refractory hepatic encephalopathy after insertion of TIPS: long-term results of shunt reduction with hourglass-shaped balloon-expandable stent-graft. AJR Am J Roentgenol 2009; 193 (06) 1696-1702
    CrossrefPubMedGoogle Scholar
  • 25 Madoff DC, Perez-Young IV, Wallace MJ, Skolkin MD, Toombs BD. Management of TIPS-related refractory hepatic encephalopathy with reduced Wallgraft endoprostheses. J Vasc Interv Radiol 2003; 14 (03) 369-374
    CrossrefPubMedGoogle Scholar
  • 26 Kroma G, Lopera J, Cura M, Suri R, El-Merhi F, Reading J. Transjugular intrahepatic portosystemic shunt flow reduction with adjustable polytetrafluoroethylene-covered balloon-expandable stents. J Vasc Interv Radiol 2009; 20 (07) 981-986
    CrossrefPubMedGoogle Scholar
  • 27 Khan A, Bailey CW. Unique Method of Transjugular Intrahepatic Portosystemic Shunt Reduction for Refractory Hepatic Encephalopathy. Cureus 2021; 13 (10) e18838
    PubMedGoogle Scholar
  • 28 Jacquier A, Vidal V, Monnet O. et al. A modified procedure for transjugular intrahepatic portosystemic shunt flow reduction. J Vasc Interv Radiol 2006; 17 (08) 1359-1363
    CrossrefPubMedGoogle Scholar
  • 29 Maleux G, Heye S, Verslype C, Nevens F. Management of transjugular intrahepatic portosystemic shunt induced refractory hepatic encephalopathy with the parallel technique: results of a clinical follow-up study. J Vasc Interv Radiol 2007; 18 (08) 986-992 , quiz 993
    CrossrefPubMedGoogle Scholar
  • 30 Sze DY, Hwang GL, Kao JS. et al. Bidirectionally adjustable TIPS reduction by parallel stent and stent-graft deployment. J Vasc Interv Radiol 2008; 19 (11) 1653-1658
    CrossrefPubMedGoogle Scholar
  • 31 Matteo J, Caci D, Soule E, Cunningham J, Hood P. Precision onion skinning technique for transjugular intrahepatic portosystemic shunt revision. Cureus 2018; 10 (08) e3180
    PubMedGoogle Scholar
  • 32 Sarwar A, Esparaz AM, Chakrala N. et al. Efficacy of TIPS Reduction for Refractory Hepatic Encephalopathy, Right Heart Failure, and Liver Dysfunction. AJR Am J Roentgenol 2021; 216 (05) 1267-1272 https://pubmed.ncbi.nlm.nih.gov/33703927
    CrossrefPubMedGoogle Scholar
  • 33 Nwawka OK, Bathala T, Kabutey NK, Kim D. Simple technique for transjugular intrahepatic portosystemic shunt reduction using a flared stent graft. J Vasc Interv Radiol 2012; 23 (09) 1251-1253
    CrossrefPubMedGoogle Scholar