- IR guided needle from hepatic vein to intrahepatic branch of portal vein maintained by a stent
- Indications (for various complications of portal hypertension):
- Refractory ascites
- Hepatic hydrothorax (pleural effusion)
- Portal hypertensive gastropathy
- Hepatorenal syndrome
- Rescue therapy for treating active variceal bleeding (success rate 95%, rebleeding rate 18%)
- Absolute contraindications:
- Primary prevention of variceal bleeding
- Right heart:
- Severe heart failure
- Tricuspid regurgitation
- Severe pulmonary hypertension
- Intrahepatic:
- Multiple hepatic cysts
- Unrelieved biliary obstruction
- Uncontrolled sepsis
- Relative contraindications:
- Liver: Centrally placed hepatomas
- Veins:
- Obstruction of all hepatic veins
- Significant portal vein thrombosis
- Moderate pulmonary hypertension
- Blood:
- Severe un-correctable coagulopathy (INR > 5)
- Thrombocytopenia (plt < 20,000/cm3)
- Complications:
- Worsening encephalopathy (due to shunting of portal blood without clearance of toxins via liver)
- Procedure related:
- Damage to structures - perforation of liver capsule, biliary puncture, hepatic artery injury
- Intraperitoneal bleeding
- Hepatic infarction
- Fistulisation
- Haemolysis
- Longer term:
- Stent infection
- Stent thrombosis
- Stent stenosis
- Stent migration
- MELD score better than Child-Pugh at predicting post-TIPSS mortality