Early complication of TIPSS is

Transjugular intrahepatic poosystemic stent shunts The emergency management of variceal haemorrhage has been revolutionised by the introduction of transjugular intrahepatic poosystemic stent shunts (TIPSS). Over a sho period, this has become the main treatment of variceal haemorrhage that has not responded to drug treatment and endoscopic therapy. The shunts are inseed under local anaesthetic, analgesia and sedation, using fluoroscopic guidance and ultrasonography. Via the internal jugular vein and SVC, a guidewire is inseed into a hepatic vein and through the hepatic parenchyma into a branch of the poal vein. The track through the parenchyma is then dilated with a balloon catheter to allow inseion of a metallic stent, which is expanded once a satisfactory position is achieved to form a channel between systemic and poal venous systems. A satisfactory drop in poal venous pressure is usually associated with good control of the variceal haemorrhage. The main early complication of this technique is perforation of the liver capsule, which can be associated with fatal intraperitoneal haemorrhage. TIPSS occlusion may result in fuher variceal haemorrhage and occurs more commonly in patients with well-compensated liver disease and good synthetic function. Post-shunt encephalopathy is a confusional state caused by the poal blood bypassing the detoxification of the liver. It occurs in about 40% of patients, a similar incidence to that found after surgical shunts. If severe, the lumen of the TIPSS can be reduced by inseion of a smaller stent. T he main contraindication to TIPSS is poal vein occlusion. The main long-term complication of TIPSS is stenosis of the shunt, which is common (approximately 50% at 1 year) and may present as fuher variceal haemorrhage. Ref: Bailey and love 27th edition pgno:1164