RadioGraphics, Vol 13, 1185-1210, Copyright © 1993 by Radiological Society of North America

REVIEWS

Complications of transjugular intrahepatic portosystemic shunt: a comprehensive review

AM Freedman, AJ Sanyal, J Tisnado, PE Cole, ML Shiffman, VA Luketic, PP Purdum, MD Darcy and MP Posner
Department of Radiology, Medical College of Virginia, Virginia Commonwealth University, Main Hospital, Richmond 23298-0615.

It is generally accepted that the transjugular intrahepatic portosystemic shunt (TIPS) procedure has lower morbidity and mortality rates than those of surgical shunting. Nevertheless, complications occur. The authors have reviewed their experience and that of other institutions in compiling an extensive list of complications. Complications are categorized according to those related to transhepatic needle puncture, transvenous access to the portal vein, portal venous cannulation, the stent, the puncture site, portosystemic shunting, and contrast material. Excluding hepatic encephalopathy and delayed stenosis or occlusion of the shunt, an overall complication rate of less than 10% can be expected for TIPS. The prevalence of aggravated or new cases of encephalopathy is 5%-35%, and over the long term, up to 75% of shunts may undergo stenosis or occlusion. The direct procedural mortality rate is less than 2%, and the 30-day mortality rate ranges from 4% to 45%, depending on several factors. The role to which TIPS is relegated will be influenced by the long-term success rate in the prevention of recurrent variceal hemorrhage.