Transjugular Intrahepatic Portosystemic Shunt

Airway: Access: Pain: Position: Time: Blood loss: Special:

Creation of a direct communication between a hepatic vein and the portal vein, decompressing the portal circulation and reducing the sequelae of portal hypertension.

Indications include:

• Acute variceal bleeding
• Variceal disease
• Refractory ascites
• Hypertensive gastropathy
• Hepatorenal syndrome
• Budd-Chiari syndrome not responsive to anticoagulation

Surgical Stages

Preoperative

Assessment:

• Right heart failure
  ↑ VR and RV preload.
• Concurrent infection
  ↑ Risk of stent infection.

Consultation:

Optimisation:

Premedication:

Explain/Consent:

Intraoperative

Preparation:

Induction:

Maintenance:

Echocardiography:

Emergence:

Postoperative

Disposition:

Referrals/Review:

Analgesia:

Fluids:

Thromboprophylaxis:

Specific:

• Complications include:
  • C
    • Tricuspid endocarditis
    • Right heart failure
  • D
    • Worsening hepatic encephalopathy
      May worsen due to diversion of unfiltered blood.
  • G
    • Portal vein thrombosis
    • Ischaemic hepatitis
      Hepatic ischaemia may occur due to ↓ portal venous flow.
  • I
    • Shunt infection

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References