Interventional Radiology

Your ultimate resource for Interventional Radiology teaching files and Interventional Radiology imaging & case of the day. Improve your diagnostic imaging skills online.

Identify this procedure. What are the indications for performing it?
Thumbnail imageThumbnail image
Thumbnail imageThumbnail image

Transjugular Intrahepatic Portosystemic Shunt (TIPS)

  • Established Indications: Portal hypertension with variceal bleeding that has failed endoscopic treatment. Refractory ascites
  • Tips is intended to decrease portal vein pressures in patients with portal hypertension by creating a conduit for blood to bypass the hepatic parenchyma and enter the systemic circulation
  • General Principles: Confirm portal vein patency prior to procedure (US, CT, or angiography) preprocedure paracentesis may be helpful. Right internal jugular vein is the preferred access vessel
  • Goal of procedure: Portal-systemic gradient of 10 mm Hg (ideal is 10 mm, any less and shunt may not remain patent, any more and not adequately therapeutic), decompression of varices
  • Contraindications: Polycystic liver dz, hepatic failure, severe right-sided failure, severe hepatic encephalopathy, severe portal vein thrombosis, active infection, larger liver hypervascular tumor
  • Results: Patency is 50% at 1 year. Recurrent bleeding in 10%


  • Right IJV approach
  • Obtain wedged hepatic pressure and venogram
  • Create tract from right hepatic vein to the portal vein (16 gauge needle)
  • Advance catheter over wire into portal venous system
  • Obtain portal venogram
  • Measure portal pressures
  • Dilate tract with PTA balloon (8 mm)
  • Deploy metallic stent (Palmaz or Wallstent)
  • Dilate stent until gradient < 10 mm HG
  • Coil embolization of varices is optional


  • Hepatic Encephalopathy
  • Bleeding
  • Shunt Thrombosis or Stenosis
  • Right Heart Failure
  • Renal Failure

Signs of Malfunction

  • No flow
  • Low velocity flow (<50-60 cm="" sec="" at="" portal="" venous="" end="" of="" shunt="" span="">
  • Reversal of flow in hepatic vein away from IVC
  • Hepatopedal flow in intrahepatic portal vein
  • Reaccumulation of ascites; recanalized umbilical veins
Tags ,
These signals are relayed buying clomid online safe which then is by a number of such as medial preoptic and paraventricular nulcei.