The shunt itself is created by placing a stent between the portal vein and the hepatic vein. The resultant shunting of portal venous flow to the systemic circulation helps reduce the portosystemic gradient and alleviate bleeding and ascites without changing the extrahepatic anatomy.
The most common conduit is between the right hepatic vein (HV) and the right portal vein (PV).
Refractory variceal hemorrhage
Hepatorenal syndrome (types 1 and 2)
Portal hypertensive gastropathy
Hepatic Veno-occlusive disease
Hepatocellular Carcinoma, especially centrally located
Primary prevention of variceal bleeding
Obstruction of all hepatic veins
Congestive heart failure
Portal vein thrombosis
Severe tricuspid regurgitation
Moderate pulmonary hypertension
Severe pulmonary hypertension
Severe coagulopathy (international normalized ration >5)
Multiple hepatic cysts
Thrombocytopenia of <20,000 cells/cm3
Uncontrolled systemic infection or sepsis
Unrelieved biliary obstruction
Originally developed to evaluate the risk of portocaval shunt procedures performed for portal hypertension. It is also useful in predicting the surgical risks of other intra-abdominal operations performed in cirrhotic patients.
Modified Model for End-Stage Liver Disease score (MELD):
For predicting post-TIPS survival; superior to CPT score and Emory score