Shunting Procedures.

What are Limitations of the TIPS procedure?

Limitations include the increased risk of hepatic encephalopathy and stenosis of the stent.

Does TIPS interfere with a future liver transplant?

No, it does not interfere with a future liver transplantation.

Nonsurgical and surgical methods of shunting.

Nonsurgical and surgical methods of shunting blood away from the varices are available.

TIPS is contraindicated in who?

TIPS is contraindicated In patients with severe hepatic encephalopathy, hepatocellular carcinoma, severe hepato-renal syndrome, and portal vein thrombosis.

Where is the catheter placed for TIPS?

A catheter is placed in the jugular vein and then threaded through the superior and inferior vena cava to the hepatic vein. ---- The wall of the hepatic vein is punctured, and the catheter is directed to the portal vein. Stents are positioned along the passageway, overlapping in the liver tissue and extending into both veins.

When are Shunting Procedures often used?

Shunting procedures tend to be used more after a second major bleeding episode than during an initial bleeding episode.

Various surgical shunting procedures may be used for what?

They may be used to decrease portal hypertension by diverting some of the portal blood flow while allowing adequate liver perfusion. Currently, the surgical shunts most commonly used are the portacaval shunt and the distal splenorenal shunt (Fig. 44-9).

Trans-jugular intrahepatic porto-systemic shunt (TIPS).

This is a non-surgical procedure in which a tract (shunt) between the systemic and portal venous systems is created to redirect portal blood flow.

What does TIPS do?

This procedure reduces portal venous pressure and decompresses the varices, thus controlling bleeding.