Transjugular intrahepatic portosystemic shunt (TIPS) (CME) – online course
Authors: E. Brountzos and A. Krajina
Reviewers: T. Jahnke, D. Tsetis, M. Tsitskari, R. Uberoi and C. Nice
Transjugular intrahepatic portosystemic shunt (TIPS) is a percutaneous, minimally invasive method of creating a portosystemic shunt for decompression of portal hypertension. TIPS is a side-to-side shunt of 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 is used to puncture the liver from a central portion of the hepatic vein and enter the main portal branch. The needle tract is then dilated by a balloon catheter, establishing a connection between the portal and systemic circulation directly inside the liver parenchyma. The parenchymal tract is kept open by insertion of a self expandable stent-graft. TIPS offers an effective treatment for patients with complications of portal hypertension, mainly prevention of variceal rebleeding and recurrent or refractory ascites. TIPS reduces portal pressure and increases effective blood volume and cardiac output. Its long-term adverse effects include risk of liver failure, hepatic encephalopathy, and cardiac dysfunction. An appropriate timing of the procedure is important in patients at high risk for rebleeding. For this group of patients, TIPS offers clinical benefits when performed early in the disease course. Technical points, such as diameter control and downsizing stent-grafts, may reduce adverse events and increase the clinical benefit of the TIPS.
This course corresponds to chapter 188.8.131.52.4 Portal and Hepatic Venous Interventions in the European Curriculum and Syllabus for IR.
- To learn about the 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 technique of the TIPS procedure
- To read postprocedural orders, management, and follow-up of patients after TIPS
- To analyse periprocedural and long-term complications of TIPS
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 IR and corresponds to chapter 184.108.40.206.4 Portal and Hepatic Venous Interventions.
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 hour and is accredited by the European Accreditation Council for Continuing Medical Education (EACCME) to award 1 European CME credit (ECMEC). The CME accreditation for this course will expire on December 20, 2021. A non-CME accredited version of the course will remain available until the new CME accredited course is published.
Upon purchase, access to complete and revisit the course is granted for an enrolment period of 90 days.
The CME certificate will be available in the myCIRSE area past the enrolment period if the course is completed before December 20, 2021.
Release date: December 2019