Question:
Which of the following statements regarding the TIPS procedure is incorrect?
Which of the following statements regarding the TIPS procedure is incorrect?
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TIPS Complications:
- Hepatic Encephalopathy: Worsens post-TIPS due to bypassing hepatic clearance.
- Shunt Stenosis: Common (often within 1 year) due to neointimal hyperplasia. Requires strict Doppler US surveillance.
- Hepatic Encephalopathy: Worsens post-TIPS due to bypassing hepatic clearance.
- Shunt Stenosis: Common (often within 1 year) due to neointimal hyperplasia. Requires strict Doppler US surveillance.
Updated On: Sep 3, 2026
- Stent stenosis is rare within the first year
- Shunt stenosis is more often due to neointimal hyperplasia than thrombosis
- Balloon dilation can correct shunt stenosis
- Recurrent portal hypertensive bleeding can occur when the shunt becomes stenosed
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The Correct Option is A
Solution and Explanation
Concept:
The Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedure is a crucial radiological intervention to decompress portal hypertension, but it carries a high rate of hardware-related complications.
Explanation:
• The TIPS procedure creates an artificial channel within the liver parenchyma connecting the portal vein to the hepatic vein, stented open to maintain flow.
• Option A: This statement is false. Stent stenosis or occlusion is actually a very common complication, especially within the first year. Before the advent of PTFE-covered stents, dysfunction rates approached 50% at 1 year. Even with modern covered stents, stenosis is frequent enough that routine Doppler ultrasound surveillance is mandatory to detect early failure. It is by no means "rare".
• Option B: Shunt compromise is biologically driven primarily by pseudointimal (neointimal) hyperplasia, where tissue overgrows through the stent mesh, rather than by acute thrombosis.
• Option C: When stenosis is detected, it can effectively be treated with endovascular balloon angioplasty or by deploying a secondary stent inside the original one.
• Option D: If the shunt stenoses, portal pressure rises again. Consequently, the patient becomes susceptible to recurrent variceal hemorrhage, mimicking their pre-TIPS state.
Final Answer:
Stent stenosis is a frequent and expected complication within the first year of a TIPS procedure, making the assertion that it is "rare" completely incorrect.
The Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedure is a crucial radiological intervention to decompress portal hypertension, but it carries a high rate of hardware-related complications.
Explanation:
• The TIPS procedure creates an artificial channel within the liver parenchyma connecting the portal vein to the hepatic vein, stented open to maintain flow.
• Option A: This statement is false. Stent stenosis or occlusion is actually a very common complication, especially within the first year. Before the advent of PTFE-covered stents, dysfunction rates approached 50% at 1 year. Even with modern covered stents, stenosis is frequent enough that routine Doppler ultrasound surveillance is mandatory to detect early failure. It is by no means "rare".
• Option B: Shunt compromise is biologically driven primarily by pseudointimal (neointimal) hyperplasia, where tissue overgrows through the stent mesh, rather than by acute thrombosis.
• Option C: When stenosis is detected, it can effectively be treated with endovascular balloon angioplasty or by deploying a secondary stent inside the original one.
• Option D: If the shunt stenoses, portal pressure rises again. Consequently, the patient becomes susceptible to recurrent variceal hemorrhage, mimicking their pre-TIPS state.
Final Answer:
Stent stenosis is a frequent and expected complication within the first year of a TIPS procedure, making the assertion that it is "rare" completely incorrect.
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