THE USE OF TRANSJUGULAR PORTOSYSTEMIC SHUNTS (TIPS) IN THE PROPHYLAXIS AND TREATMENT OF PORTAL HYPERTENSION SYNDROME: A BIBLIOGRAPHIC REVIEW

Abstract

Introduction. Portal hypertension (PH) is a major hemodynamic consequence of chronic liver diseases and leads to significant morbidity and mortality due to complications such as variceal hemorrhage, refractory ascites, hydrothorax, hepatorenal syndrome, and other vascular and metabolic manifestations. Hemodynamic measurements, such as the hepatic venous pressure gradient (HVPG) and the portosystemic pressure gradient (PPG), are essential parameters for evaluating bleeding risk and treatment response, being correlated with disease severity and progression.

Methods. This work is a structured narrative review, guided by PRISMA principles, analyzing literature published between 2010 and 2025 from PubMed, Scopus, and Web of Science, as well as references extracted from the provided bibliography. The included studies are clinical, observational, meta-analyses, and case series, focusing on indications, techniques, clinical results, and complications related to TIPS. Data extraction was performed according to a standardized protocol, with quality assessment of the studies and interpretation of the results within the context of existing heterogeneity.

Results. TIPS proves to be a safe and effective technique for reducing HVPG and controlling refractory variceal hemorrhage and refractory ascites. Technical success rates exceed 90% in most studies, and covered stents (e-PTFE) have improved patency and reduced reinterventions. Early TIPS, placed within the first 72 hours, has decreased mortality and rebleeding recurrence in high-risk populations and in comparative studies. Major complications include hepatic encephalopathy, with incidences varying from 10% to 50%, influenced by patient selection, shunt diameter, and techniques used. Modern innovations, such as IVUS guidance, portal vein recanalization, and trans-splenic approaches, expand indications and reduce risks in complex cases.

Conclusions. TIPS is a fundamental therapy in managing portal hypertension complications, effective in controlling hemorrhages and refractory ascites. The implementation of modern techniques and rigorous patient selection increase success and reduce complications. However, prospective studies are needed to clarify emerging indications and methods for preventing post‑TIPS encephalopathy.