Transjugular intrahepatic portosystemic shunt (TIPS) (2025) – online course

Description

Please note that this course is no yet CME accredited.

Authors: A. Krajina and P. Lucatelli

(Authors of the original material: E. Brountzos and A. Krajina)

Reviewers: A. Gjoreski, A.M. Ierardi, S. Hopf-Jensen, D. Kusumawidjaja, R. Lakshminarayan, C. Nice and P. Reimer

This course corresponds to chapters 2.2.1.3.4 Portal and hepatic venous interventions and 2.2.1.3.4.1 Portal venous disease and transjugular intrahepatic portosystemic shunt (TIPS) and balloon-occluded retrograde transvenous obliteration (BRTO) and 2.2.1.3.4.2 Hepatic venous disease and Budd-Chiari syndrome in the European Curriculum and Syllabus for Interventional Radiology.

Abstract

Transjugular intrahepatic portosystemic shunt (TIPS) is a percutaneous, minimally invasive procedure used to create a portosystemic shunt to decompress portal hypertension. TIPS is a side-to-side shunt of a determined diameter, designed to function as a partial shunt that preserves a portion of portal flow to the liver. A needle inserted transjugularly through the catheter punctures the liver from a central portion of the hepatic vein to access the main portal branch. The needle tract is then dilated with a balloon catheter, establishing a connection between the portal and systemic circulation directly inside the liver parenchyma. The parenchymal tract is kept open by the insertion of a self-expandable stent graft.

TIPS is an effective treatment for patients with complications of portal hypertension, primarily for preventing variceal rebleeding and managing recurrent or refractory ascites. Less common indications include massive thrombosis of the hepatic veins and thrombosis of the portal vein and its tributaries. TIPS reduces portal pressure and increases effective blood volume and cardiac output. Its long-term adverse effects include risks of liver failure, hepatic encephalopathy, and cardiac dysfunction. An important consideration is the timing of intervention in patients at high risk for rebleeding. For this group of patients, TIPS offers clinical benefits when performed within 48 hours of disease onset. Technical adjustments, such as diameter control and downsizing stent grafts, may reduce adverse events and enhance clinical outcomes.

Learning objectives

• To learn about liver anatomy and pathophysiology of portal hypertension
• To learn about the clinical presentation of a patient with decompensated portal hypertension
• To study indications and timing for percutaneous decompression of portal hypertension
• To learn about the techniques of the TIPS procedure
• To read postprocedural orders, management, and follow-up of patients after TIPS
• To analyze the outcome and periprocedural and long-term complications of TIPS

Further information

This course covers a basic level of IR knowledge and is designed for trainees, students or young consultants aiming to acquire essential knowledge or prepare for the EBIR exam. Thereby, it is tailored to the European Curriculum and Syllabus for Interventional Radiology and corresponds to chapter 2.2.1.3.4 Portal and hepatic venous interventions, 2.2.1.3.4.1 Portal venous disease and transjugular intrahepatic portosystemic shunt (TIPS) and balloon-occluded retrograde transvenous obliteration (BRTO) and 2.2.1.3.4.2 Hepatic venous disease and Budd-Chiari syndrome.

The format of the course is interactive and easy to use, including texts, graphics, videos and a quiz to support your learning. The course duration is around one and a half hours.

The enrolment period of this course is linked to the validity of the All-Access Pass.

Release date: April 2025