The use of the transjugular intrahepatic portosystemic shunt: a literature review

Guoda Jankaitytė1

1Faculty of Medicine, Vilnius University, Vilnius, Lithuania


Transjugular intrahepatic portosystemic shunt functions as a low-resistance pathway, or a bypass, which helps the blood from the digestive tract to pass straight into the inferior vena cava and to outrun the microcirculation in the liver – a high-resistance pathway that occurs due to injury of the liver parenchyma or portal vein thrombosis. There are two main indications for this shunt – secondary prevention from esophageal variceal bleeding and recurrent ascites. It is always important to evaluate the patient’s status because with severe illnesses or advanced hepatic encephalopathy the procedure can make the patient’s condition even worse. After the shunt is completed, it is important to monitor the patient for complications that can be associated with the technique of stent placement, the stent itself, or hemodynamic changes, which occur after the portosystemic shunt implantation. Moreover, the functioning of the shunt needs to be evaluated – blood velocity and the risk of possible complications measured. Disfunction of the stent should be suspected when blood direction in the intrahepatic portal venous branches changes from hepatofugal to hepatopetal and newly present, recurrent, or worsening ascites occurs.

Aim. The aim of this review – discuss the use of transjugular intrahepatic portosystemic shunt as a treatment for various conditions which occur due to chronic liver diseases and to review the indications and contraindications of the shunt placement.

Material and methods. A review was made after gathering publications and articles from these databases: PubMed, Web of Science, Google Scholar, and Scopus. Relevant keywords were entered in the advanced search panel to gather data. After reviewing all the exclusion criteria, 33 scientific articles were included in this literature review.

Conclusion: despite the course of the procedure and possible complications, the transjugular intrahepatic portosystemic shunt is an effective treatment for portal hypertension and other diseases, which disturbs microcirculation and hemodynamics in the liver.

Keywords: transjugular intrahepatic portosystemic shunt, TIPS, liver.