Bosch, Jaime (2021). Small diameter shunts should lead to safe expansion of the use of TIPS. Journal of hepatology, 74(1), pp. 230-234. Elsevier 10.1016/j.jhep.2020.09.018
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TIPS is increasingly used worldwide in the treatment of complications from of portal hypertension in advanced cirrhosis. However, its use is hampered by the risk of causing hepatic encephalopathy and of worsening liver function. Reported hemodynamic targets for guiding TIPS are too narrow for being achieved in most cases, and perhaps not entirely adequate nowadays since obtained in the pre-covered stent era. We propose that small diameter TIPS - alone or combined to pharmacological therapy or ancillary interventional radiology procedures- may overcome these limitations while maintaining its beneficial effects by itself or by associating simple additional treatments or procedures.
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