Abstract
The decision to perform a transjugular intrahepatic portosystemic shunts (TIPS) requires multidisciplinary input from gastroenterology/hepatology, interventional radiology, and, when appropriate, transplant surgery. In general, a TIPS set consists of a long access sheath, an angled catheter for selection of the hepatic veins, a puncture needle, and a wire. This chapter prefers the use of general anesthesia for the TIPS procedure. The 2009 American Association for the Study of Liver Diseases (AASLD) Practice Guidelines endorse TIPS in controlling acute bleeding from varices refractory to medical therapy. TIPS is used to control active gastric variceal bleeding and prevent rebleeding, it has been reported to control active bleeding in 90-96% of cases. The chapter discusses authors' recommentation of Model for End-Stage Liver Disease (MELD)-based scoring system to optimize patient selection for TIPS and providing more accurate counseling of patients on expected outcome. Other scoring systems, such as Emory score, should be used as secondary options. © 2017 John Wiley & Sons, Ltd. All rights reserved.