Portal Hypertension · IR Playbook

TIPS Revision for Stenosis, Occlusion or Dysfunction (TIPS revision)

TIPS revision is the endovascular re-intervention performed on a previously created transjugular intrahepatic portosystemic shunt that has narrowed, thrombosed or otherwise ceased to decompress the portal system. The shunt works only as a low-resistance conduit, so any reduction in its effective lumen — pseudointimal hyperplasia through the interstices of a bare stent, tissue ingrowth or thrombus within a covered stent-graft, or a stenosis in the hepatic vein outflow segment — raises the portosystemic gradient back towards the bleeding and ascites threshold, which is why dysfunction presents as recurrence of the original indication rather than as a new syndrome. Revision restores the conduit by angioplasty, relining with an ePTFE-covered stent-graft, or extension of the covered segment to the hepatic vein–IVC junction. Even with ePTFE-covered stent-grafts, shunt dysfunction still occurs in approximately 8–20% of patients at one year, so surveillance and revision are integral to the TIPS programme rather than exceptional events.

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