Transjugular intrahepatic portasystemic stent—shunt in the treatment of variceal haemorrhage
Article first published online: 8 DEC 2005
Copyright © 1995 British Journal of Surgery Society Ltd.
British Journal of Surgery
Volume 82, Issue 9, pages 1158–1164, September 1995
How to Cite
Jalan, R., Redhead, D. N. and Hayes, P. C. (1995), Transjugular intrahepatic portasystemic stent—shunt in the treatment of variceal haemorrhage. Br J Surg, 82: 1158–1164. doi: 10.1002/bjs.1800820905
- Issue published online: 8 DEC 2005
- Article first published online: 8 DEC 2005
- Manuscript Accepted: 30 MAR 1995
The transjugular intrahepatic portasystemic stent-shunt (TIPSS) is a side-to-side portocaval shunt, performed by interventional radiological methods, linking the hepatic and portal veins through the liver parenchyma with an expandable metal stent. The technique can be performed successfully in over 90 per cent of patients. The procedure-related mortality rate is about 1 per cent, mainly from intraperitoneal bleeding. The main indications for TIPSS insertion are control of acute variceal bleeding in patients with cirrhosis that is refractory to sclerotherapy and recurrent variceal haemorrhage despite sclerotherapy or band ligation. TIPSS insertion is followed by variceal rebleeding in about 10–20 per cent of cases, encephalopathy in 10–20 per cent, transient deterioration of liver function in 25–35 per cent and subsequent shunt dysfunction over a 6–12-month period in 15–60 per cent. The final place of TIPSS insertion in the management of portal hypertension is being evaluated in controlled studies, but its use in the treatment of uncontrolled variceal haemorrhage seems assured.