Recent position of transjugular intrahepatic portosystemic shunt in the treatment of portal hypertension.

Transjugular intrahepatic portosystemic shunt (TIPS) is a side-to-side portocaval shunt for threatening complications of portal hypertension. TIPS effectively decreases portal hypertension connecting the hepatic and portal vein with an expandable metal stent without the mortality and morbidity of an open surgical procedure. Technical success can be achieved in over 90% of patients, with procedure related mortality of 1-2%. The main problem is stenosis or occlusion of the shunt by neo-intimal hyperplasia narrowing the lumen of the shunt in 20-80% of patients during 6-12 months, but fortunately, most stenotic stents can be revised successfully. Recent indications for TIPS are acute variceal hemorrhage refractory to endoscopic treatment and recurrent variceal bleeding despite sclerotherapy or band ligation. TIPS insertion in the treatment of refractory ascites seems to be promising.