What are the limitations to the use of transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of cirrhosis?

Updated: Jul 30, 2018
  • Author: David C Wolf, MD, FACP, FACG, AGAF, FAASLD; Chief Editor: BS Anand, MD  more...
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Answer

Answer

Both a pre-TIPS bilirubin level of greater than 3 mg/dL and a pre-TIPS Model for End-Stage Liver Disease (MELD) score of greater than 18 (see the MELD Score calculator) are associated with an increased mortality rate when a TIPS is created for the management of ascites. [30, 31] In the author's opinion, TIPS use should be reserved for patients with Child Class B cirrhosis or patients with Child Class C cirrhosis without severe coagulopathy or encephalopathy.

In the 1990s, shunt stenosis was observed in one half of cases within 1 year of TIPS placement, necessitating angiographic revision. Although the advent of coated stents appears to have reduced the incidence of shunt stenosis, patients must still be willing to return to the hospital for Doppler and angiographic follow-up of TIPS patency.


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