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Gastrointestinal
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Liver
Treatment Related
Transjugular Intrahepatic Portosystemic Shunt (TIPS)
Transjugular Intrahepatic Portosystemic Shunt (TIPS)
Atif Zaheer, MD; Michael P. Federle, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Transjugular intrahepatic portocaval shunt (TIPS)

              • Definitions

                • Shunt between main portal vein (PV) and hepatic vein (HV) created with balloon-expandable metallic stent
                • Hepatopetal blood flow: Toward liver
                • Hepatofugal blood flow: Away from liver

              IMAGING

              • General Features

                • Ultrasonographic Findings

                  • Other Modality Findings

                    • Imaging Recommendations

                      • Angiographic Findings

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              • Gross Pathologic & Surgical Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Rajesh S et al: Transjugular intrahepatic portosystemic shunt in cirrhosis: an exhaustive critical update. World J Gastroenterol. 26(37):5561-96, 2020
                                          2. Vizzutti F et al: Transjugular intrahepatic portosystemic shunt (TIPS): current indications and strategies to improve the outcomes. Intern Emerg Med. 15(1):37-48, 2020
                                          3. Hung ML et al: Role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension: review and update of the literature. Clin Liver Dis. 23(4):737-54, 2019
                                          4. Manatsathit W et al: Performance of ultrasound for detection of transjugular intrahepatic portosystemic shunt dysfunction: a meta-analysis. Abdom Radiol (NY). 44(7):2392-402, 2019
                                          5. Strunk H et al: Transjugular intrahepatic portosystemic shunt (TIPS): pathophysiologic basics, actual indications and results with review of the literature. Rofo. 190(8):701-11, 2018
                                          6. Orloff MJ: Fifty-three years' experience with randomized clinical trials of emergency portacaval shunt for bleeding esophageal varices in Cirrhosis: 1958-2011. JAMA Surg. 149(2):155-69, 2014
                                          7. Kirby JM et al: Image-guided intervention in management of complications of portal hypertension: more than TIPS for success. Radiographics. 33(5):1473-96, 2013
                                          8. Qin JP et al: Clinical effects and complications of TIPS for portal hypertension due to cirrhosis: a single center. World J Gastroenterol. 19(44):8085-92, 2013
                                          9. Micol C et al: Contrast-enhanced ultrasound: a new method for TIPS follow-up. Abdom Imaging. 37(2):252-60, 2012
                                          10. Wu X et al: Favorable clinical outcome using a covered stent following transjugular intrahepatic portosystemic shunt in patients with portal hypertension. J Hepatobiliary Pancreat Sci. 17(5):701-8, 2010
                                          11. Kim MJ et al: Technical essentials of hepatic Doppler sonography. Curr Probl Diagn Radiol. 38(2):53-60, 2009
                                          12. Bureau C et al: Patency of stents covered with polytetrafluoroethylene in patients treated by transjugular intrahepatic portosystemic shunts: long-term results of a randomized multicentre study. Liver Int. 27(6):742-7, 2007
                                          13. Maleux G et al: Dynamic MR perfusion measurements before and after TIPS in cirrhotic patients with refractory ascites. Acad Radiol. 14(11):1400-8, 2007
                                          14. Bauer J et al: The role of TIPS for portal vein patency in liver transplant patients with portal vein thrombosis. Liver Transpl. 12(10):1544-51, 2006
                                          15. Carr CE et al: Role of ultrasound surveillance of transjugular intrahepatic portosystemic shunts in the covered stent era. J Vasc Interv Radiol. 17(8):1297-305, 2006
                                          16. Harrod-Kim P et al: Predictors of early mortality after transjugular intrahepatic portosystemic shunt creation for the treatment of refractory ascites. J Vasc Interv Radiol. 17(10):1605-10, 2006
                                          17. Barrio J et al: Comparison of transjugular intrahepatic portosystemic shunt dysfunction in PTFE-covered stent-grafts versus bare stents. Eur J Radiol. 55(1):120-4, 2005
                                          18. Benito A et al: Doppler ultrasound for TIPS: does it work? Abdom Imaging. 29(1):45-52, 2004
                                          19. Middleton WD et al: Doppler evaluation of transjugular intrahepatic portosystemic shunts. Ultrasound Q. 19(2):56-70; quiz 108-10, 2003
                                          20. Bodner G et al: Color and pulsed Doppler ultrasound findings in normally functioning transjugular intrahepatic portosystemic shunts. Eur J Ultrasound. 12(2):131-6, 2000
                                          21. Ong JP et al: Transjugular intrahepatic portosystemic shunts (TIPS): a decade later. J Clin Gastroenterol. 30(1):14-28, 2000
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Pathology

                                                  • Clinical Issues

                                                    • Diagnostic Checklist

                                                      TERMINOLOGY

                                                      • Abbreviations

                                                        • Transjugular intrahepatic portocaval shunt (TIPS)

                                                      • Definitions

                                                        • Shunt between main portal vein (PV) and hepatic vein (HV) created with balloon-expandable metallic stent
                                                        • Hepatopetal blood flow: Toward liver
                                                        • Hepatofugal blood flow: Away from liver

                                                      IMAGING

                                                      • General Features

                                                        • Ultrasonographic Findings

                                                          • Other Modality Findings

                                                            • Imaging Recommendations

                                                              • Angiographic Findings

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Staging, Grading, & Classification

                                                                      • Gross Pathologic & Surgical Features

                                                                        CLINICAL ISSUES

                                                                        • Presentation

                                                                          • Demographics

                                                                            • Natural History & Prognosis

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Rajesh S et al: Transjugular intrahepatic portosystemic shunt in cirrhosis: an exhaustive critical update. World J Gastroenterol. 26(37):5561-96, 2020
                                                                                  2. Vizzutti F et al: Transjugular intrahepatic portosystemic shunt (TIPS): current indications and strategies to improve the outcomes. Intern Emerg Med. 15(1):37-48, 2020
                                                                                  3. Hung ML et al: Role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension: review and update of the literature. Clin Liver Dis. 23(4):737-54, 2019
                                                                                  4. Manatsathit W et al: Performance of ultrasound for detection of transjugular intrahepatic portosystemic shunt dysfunction: a meta-analysis. Abdom Radiol (NY). 44(7):2392-402, 2019
                                                                                  5. Strunk H et al: Transjugular intrahepatic portosystemic shunt (TIPS): pathophysiologic basics, actual indications and results with review of the literature. Rofo. 190(8):701-11, 2018
                                                                                  6. Orloff MJ: Fifty-three years' experience with randomized clinical trials of emergency portacaval shunt for bleeding esophageal varices in Cirrhosis: 1958-2011. JAMA Surg. 149(2):155-69, 2014
                                                                                  7. Kirby JM et al: Image-guided intervention in management of complications of portal hypertension: more than TIPS for success. Radiographics. 33(5):1473-96, 2013
                                                                                  8. Qin JP et al: Clinical effects and complications of TIPS for portal hypertension due to cirrhosis: a single center. World J Gastroenterol. 19(44):8085-92, 2013
                                                                                  9. Micol C et al: Contrast-enhanced ultrasound: a new method for TIPS follow-up. Abdom Imaging. 37(2):252-60, 2012
                                                                                  10. Wu X et al: Favorable clinical outcome using a covered stent following transjugular intrahepatic portosystemic shunt in patients with portal hypertension. J Hepatobiliary Pancreat Sci. 17(5):701-8, 2010
                                                                                  11. Kim MJ et al: Technical essentials of hepatic Doppler sonography. Curr Probl Diagn Radiol. 38(2):53-60, 2009
                                                                                  12. Bureau C et al: Patency of stents covered with polytetrafluoroethylene in patients treated by transjugular intrahepatic portosystemic shunts: long-term results of a randomized multicentre study. Liver Int. 27(6):742-7, 2007
                                                                                  13. Maleux G et al: Dynamic MR perfusion measurements before and after TIPS in cirrhotic patients with refractory ascites. Acad Radiol. 14(11):1400-8, 2007
                                                                                  14. Bauer J et al: The role of TIPS for portal vein patency in liver transplant patients with portal vein thrombosis. Liver Transpl. 12(10):1544-51, 2006
                                                                                  15. Carr CE et al: Role of ultrasound surveillance of transjugular intrahepatic portosystemic shunts in the covered stent era. J Vasc Interv Radiol. 17(8):1297-305, 2006
                                                                                  16. Harrod-Kim P et al: Predictors of early mortality after transjugular intrahepatic portosystemic shunt creation for the treatment of refractory ascites. J Vasc Interv Radiol. 17(10):1605-10, 2006
                                                                                  17. Barrio J et al: Comparison of transjugular intrahepatic portosystemic shunt dysfunction in PTFE-covered stent-grafts versus bare stents. Eur J Radiol. 55(1):120-4, 2005
                                                                                  18. Benito A et al: Doppler ultrasound for TIPS: does it work? Abdom Imaging. 29(1):45-52, 2004
                                                                                  19. Middleton WD et al: Doppler evaluation of transjugular intrahepatic portosystemic shunts. Ultrasound Q. 19(2):56-70; quiz 108-10, 2003
                                                                                  20. Bodner G et al: Color and pulsed Doppler ultrasound findings in normally functioning transjugular intrahepatic portosystemic shunts. Eur J Ultrasound. 12(2):131-6, 2000
                                                                                  21. Ong JP et al: Transjugular intrahepatic portosystemic shunts (TIPS): a decade later. J Clin Gastroenterol. 30(1):14-28, 2000