This educational podcast from the 6th Liver Connect meeting provides a comprehensive overview of the TIPS (transjugular intrahepatic portosystemic shunt) procedure, focusing on patient selection, risk stratification, and evolving techniques to improve outcomes in patients with advanced liver disease. The discussion highlights key indications for TIPS, including recurrent or high-risk variceal bleeding, refractory or recurrent ascites, and select cases of portal vein thrombosis or hepatic venous outflow obstruction such as Budd-Chiari syndrome. Learn how early TIPS intervention can reduce rebleeding risk and improve survival in high-risk patients, as well as when TIPS should be used as salvage therapy or secondary prophylaxis. The episode also explores the importance of frailty assessment, MELD 3.0 scoring, and sarcopenia evaluation in predicting post-TIPS hepatic encephalopathy, along with strategies to optimize patients before the procedure.
Additionally, it reviews absolute contraindications such as heart failure, severe pulmonary hypertension, and uncontrolled infection, emphasizing the need for multidisciplinary decision-making. Finally, emerging data on smaller stent diameters (6–8 mm) are discussed, demonstrating how these innovations may reduce complications while maintaining effective portal decompression.
This episode is essential for clinicians managing portal hypertension, cirrhosis complications, and liver transplant candidates.