Transjugular Intrahepatic Portosystemic Shunt

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  • Portal hypertension is defined as PV pressures > 12mmHg
  • Two mechanisms for cause of PHTN
    • Deposition of collagen between cells in the spaces of Disse and hepatocyte swelling, both of which increase the sinusoidal pressure and cause a relative resistance to blood flow into the hepatic sinusoids
    • Hemodynamic factors, including intrahepatic endogenous vasoconstrictors and mesenteric vasodilators, which increase blood flow and pressure in the portal venous system.
  • Indications: intractible ascites, bleeding varices which have failed endoscopic management
  • Contraindications: right heart failure, encephalopathy, PV thrombus, active infection, hypervascular hepatic tumor
  • Placed between right hepatic vein and right portal vein after CO2 portography via hepatic vein

Patients experiencing increased portal venous pressure can see a reversal of flow in the portal system, changing form hepatopetal (toward the liver), to hepatofugal (away from the liver).

Normal Post Precedure Doppler Findings

  • Stent Flow 50-270 cm/sec
  • Varies within shunt with means from 79 cm/sec preshunt to 131 cm/sec postshunt
  • Main portal vein velocity 20-50 cm/sec

Criteria for Compromised TIPS Function

  • Shunt velocity of <50cm/sec
  • Change in shunt velocity of 50cm/sec from prior
  • Focal region of increased velocity in shunt or hepatic vein
  • Hepatopedal flow right and left portal vein branches
  • Hepatofugal flow in main portal vein


TIPS Imaging Course by GE