Hemodynamic consequences of therapeutic portosystemic shunting: recent experience with transjugular intrahepatic portosystemic shunts.

TIPS provides a side-to-side portosystemic shunt without a major abdominal operation. Although TIPS is relatively less invasive, it is associated with similar hemodynamic alterations as surgically created side-to-side shunts. An important difference is that a mild degree of portal hypertension is maintained with TIPS similar to small diameter shunts. TIPS provides effective portal decompression and prevents variceal hemorrhage. However, the risk of encephalopathy is relatively high and stenosis is a long-term concern in many patients. An important advance in the future use of TIPS will be tailoring the diameter of the shunt to optimize regional and systemic hemodynamics in a given individual to minimize the risk of bleeding or to decrease ascites accumulation while limiting the risk of hepatic encephalopathy and liver failure.