Q:

Which of the following statement(s) is/are true concerning the use of transjugular intrahepatic portosystemic shunts (TIPS) in the treatment of variceal bleeding?

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Which of the following statement(s) is/are true concerning the use of transjugular intrahepatic portosystemic shunts (TIPS) in the treatment of variceal bleeding?


  1. This procedure effectively creates an end-to-side portocaval shunt
  2. Procedure-related mortality is generally in excess of 20%
  3. TIPS has been used successfully as a pretransplant procedure to reduce portal pressure
  4. The placement of a TIPS is not associated with the development of encephalopathy

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c. TIPS has been used successfully as a pretransplant procedure to reduce portal pressure

Transjugular intrahepatic portosystemic shunts (TIPS) refer to an implantable, expandable metal stent placed radiologically through the hepatic parenchyma to establish a track between branches of the hepatic and portal veins. TIPS results in similar hemodynamics as a side-to-side portal systemic shunt. There is firm clinical data that TIPS provides effective control of acute variceal hemorrhage and portal hypertension regardless of the etiology of the underlying liver disease or the degree of hepatic decompensation. TIPS has also been used for preoperative portal decompression to facilitate orthotopic liver transplantation. Pretransplant TIPS should reduce portal pressure thereby reducing operative time and blood loss. The major complications of TIPS include encephalopathy and stenosis or occlusion of this stent. Encephalopathy occurs in 10% to 20% of patients after TIPS. This complication appears to correlate with increasing age of the patient and increased shunt diameter and shunt flow.

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