Which patients benefit the most?An update on transjugular intrahepatic portosystemic shunt  

作　　者：Angelo Alves de Mattos Angelo Zambam de Mattos Muriel Manica Cristiane Valle Tovo 

机构地区：[1]Postgraduation Program in Medicine:Hepatology,Universidade Federal de Ciências da Saúde de Porto Alegre(UFCSPA),Porto Alegre 90050-170,Rio Grande do Sul,Brazil

出　　处：《World Journal of Hepatology》2025年第2期4-13,共10页世界肝病学杂志(英文)

摘　　要：This is a narrative review in which the advances in technical aspects,the main indications,limitations and clinical results of the transjugular intrahepatic portosystemic shunt(TIPS)in portal hypertension(PH)are addressed.With the emergence of the coated prosthesis,a better shunt patency,a lower incidence of hepatic encephalopathy(HE)and better survival when compared to TIPS with the conventional prosthesis are demonstrated.The main indications for TIPS are refractory ascites,acute variceal bleeding unresponsive to pharmacological/endoscopic therapy and,lastly,patients considered at high risk for rebleeding preemptive TIPS(pTIPS).Absolute contraindications to the use of TIPS are severe uncontrolled HE,systemic infection or sepsis,congestive heart failure,severe pulmonary arterial hypertension,and biliary obstruction.The control of hemorrhage due to variceal rupture can reach up to 90%-100%of cases,and 55%in refractory ascites.Despite evidences regarding pTIPS in patients at high risk for rebleeding,less than 20%of eligible patients are treated.TIPS may also decrease the incidence of future decompensation in cirrhosis and increase survival in selected patients.In conclusion,TIPS is an essential treatment for patients with PH,but is often neglected.It is important for the hepatologist to form a multidisciplinary team,in which the role of the radiologist with experience in interventional procedures is prominent.

关 键 词：Transjugular intrahepatic portosystemic shunt Refractory ascites Variceal bleeding Portal hypertension Hepatic encephalopathy 

分 类 号：R657.3[医药卫生—外科学]