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Transjugular Intrahepatic Portosystemic Shunt (TIPS)
Aya Kamaya, MD, FSRU, FSAR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Transjugular intrahepatic portasystemic shunt (TIPS)
              • Definitions

                • Shunt between portal vein (PV) and hepatic vein (HV) created typically with balloon-expandable polytetrafluoroethylene (PTFE)-covered stent graft
                • Shunt dysfunction
                  • Reduction > 50% of shunt lumen
                  • Portosystemic gradient > 12-15 mm Hg
                  • Complete occlusion of shunt

              IMAGING

              • General Features

                • Ultrasonographic Findings

                  • Angiographic Findings

                    • Other Modality Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Indications for TIPS

                                          • Relative Contraindications for TIPS

                                            • Causes of TIPS failure

                                              DIAGNOSTIC CHECKLIST

                                              • Consider

                                                Selected References

                                                1. Brants L et al: Role of Doppler ultrasound combined with clinical features in the diagnosis of transjugular intrahepatic portosystemic shunt dysfunction in the era of covered stents. J Ultrasound Med. 48(4):572-7, 2020
                                                2. Engstrom BI et al: Covered transjugular intrahepatic portosystemic shunts: accuracy of ultrasound in detecting shunt malfunction. AJR Am J Roentgenol. 200(4):904-8, 2013
                                                3. Sajja KC et al: Long-term follow-up of TIPS created with expanded poly-tetrafluoroethylene covered stents. Dig Dis Sci. 58(7):2100-6, 2013
                                                4. Wu Q et al: Transjugular intrahepatic portosystemic shunt using the FLUENCY expanded polytetrafluoroethylene-covered stent. Exp Ther Med. 5(1):263-6, 2013
                                                5. Gazzera C et al: Fifteen years' experience with transjugular intrahepatic portosystemic shunt (TIPS) using bare stents: retrospective review of clinical and technical aspects. Radiol Med. 114(1):83-94, 2009
                                                6. 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
                                                7. 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
                                                8. Benito A et al: Doppler ultrasound for TIPS: does it work? Abdom Imaging. 29(1):45-52, 2004
                                                9. Middleton WD et al: Doppler evaluation of transjugular intrahepatic portosystemic shunts. Ultrasound Q. 19(2):56-70; quiz 108-10, 2003
                                                10. 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
                                                11. Zizka J et al: Value of Doppler sonography in revealing transjugular intrahepatic portosystemic shunt malfunction: a 5-year experience in 216 patients. AJR Am J Roentgenol. 175(1):141-8, 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 portasystemic shunt (TIPS)
                                                            • Definitions

                                                              • Shunt between portal vein (PV) and hepatic vein (HV) created typically with balloon-expandable polytetrafluoroethylene (PTFE)-covered stent graft
                                                              • Shunt dysfunction
                                                                • Reduction > 50% of shunt lumen
                                                                • Portosystemic gradient > 12-15 mm Hg
                                                                • Complete occlusion of shunt

                                                            IMAGING

                                                            • General Features

                                                              • Ultrasonographic Findings

                                                                • Angiographic Findings

                                                                  • Other Modality Findings

                                                                    • Imaging Recommendations

                                                                      DIFFERENTIAL DIAGNOSIS

                                                                        PATHOLOGY

                                                                        • General Features

                                                                          • Staging, Grading, & Classification

                                                                            • Gross Pathologic & Surgical Features

                                                                              • Microscopic Features

                                                                                CLINICAL ISSUES

                                                                                • Presentation

                                                                                  • Demographics

                                                                                    • Natural History & Prognosis

                                                                                      • Indications for TIPS

                                                                                        • Relative Contraindications for TIPS

                                                                                          • Causes of TIPS failure

                                                                                            DIAGNOSTIC CHECKLIST

                                                                                            • Consider

                                                                                              Selected References

                                                                                              1. Brants L et al: Role of Doppler ultrasound combined with clinical features in the diagnosis of transjugular intrahepatic portosystemic shunt dysfunction in the era of covered stents. J Ultrasound Med. 48(4):572-7, 2020
                                                                                              2. Engstrom BI et al: Covered transjugular intrahepatic portosystemic shunts: accuracy of ultrasound in detecting shunt malfunction. AJR Am J Roentgenol. 200(4):904-8, 2013
                                                                                              3. Sajja KC et al: Long-term follow-up of TIPS created with expanded poly-tetrafluoroethylene covered stents. Dig Dis Sci. 58(7):2100-6, 2013
                                                                                              4. Wu Q et al: Transjugular intrahepatic portosystemic shunt using the FLUENCY expanded polytetrafluoroethylene-covered stent. Exp Ther Med. 5(1):263-6, 2013
                                                                                              5. Gazzera C et al: Fifteen years' experience with transjugular intrahepatic portosystemic shunt (TIPS) using bare stents: retrospective review of clinical and technical aspects. Radiol Med. 114(1):83-94, 2009
                                                                                              6. 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
                                                                                              7. 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
                                                                                              8. Benito A et al: Doppler ultrasound for TIPS: does it work? Abdom Imaging. 29(1):45-52, 2004
                                                                                              9. Middleton WD et al: Doppler evaluation of transjugular intrahepatic portosystemic shunts. Ultrasound Q. 19(2):56-70; quiz 108-10, 2003
                                                                                              10. 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
                                                                                              11. Zizka J et al: Value of Doppler sonography in revealing transjugular intrahepatic portosystemic shunt malfunction: a 5-year experience in 216 patients. AJR Am J Roentgenol. 175(1):141-8, 2000