Management of Shunt Dysfunction in the Era of TIPS Endografts

Significantly improved long-term patency can be achieved with transjugular intrahepatic portosystemic shunt (TIPS) endografts compared to conventional bare stents. In the USA, approximately 80% of TIPS procedures are performed using these devices. The phenomenon of early shunt thrombosis with TIPS created with bare stent TIPS, attributed to biliary fistulae, is seldom observed in patients with TIPS endografts. Intrashunt stenoses within the polytetrafluoroethylene-lined conduit are also rare. However, as with shunts created with bare stents, distinct patterns of dysfunction can occur with TIPS endografts. Some of these are inherent to the learning curve of placing these devices and others are secondary to device design. The interventional radiologist needs to be aware of these patterns of shunt dysfunction and have a systematic approach to their management.