Portal hypertension is defined as an increase in the portal pressure gradient (portal pressure minus inferior vena cava pressure) that exceeds 5 mmHg. It is considered to be clinically significant when it exceeds 10mmHg, at which point complications begin to appear. The most common cause is chronic liver disease1.
The Transjugular Intrahepatic Portosystemic Shunt (TIPS) consist in creating a direct connection between the portal vein and a hepatic vein through the liver tissue to reduce portal pressure and thus, to treat portal hypertension2 (figure 1).
TIPS is mainly used for refractory ascites, secondary prophylaxis for esophageal variceal bleeding, and for uncontrolled acute variceal bleeding after first-line therapies3 (table 1).
Certain situations contraindicate the use of TIPS (table 2). Severe right heart failure, severe tricuspid valve insufficiency, pulmonary hypertension greater than 45 mmHg, severe hepatic encephalopathy, uncontrolled sepsis, and polycystic liver disease are generally accepted as absolute contraindications. Relative contraindications to consider are portal vein thrombosis, Budd-Chiari syndrome, pulmonary hypertension lower than 45 mmHg, coagulopathy, hepatic encephalopathy and malignant focal liver lesions2.
When TIPS is indicated, a preoperative ultrasound study is necessary to assess the patency of the right jugular, suprahepatic and portal veins; to measure the portal vein velocity and to compare it with the portal vein velocity after TIPS; to assess the presence of ascites, splenomegaly or collateral branches suggestive of portal hypertension; and to rule out the presence of focal hepatic lesiones2.
Since the introduction of polytetrafluoroethylene stents, stent-related complications are extremely rare. Nevertheless, there are some acute and long-term complications that, as radiologist, we have to know4 (table 3).