TIPS Indications and Contraindications—Pushing the Limits: Is Earlier Better?

  • José Ferrusquía-Acosta
  • Virginia Hernández-GeaEmail author
Management of Cirrhotic Patient (A Cardenas and P Tandon, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Management of the Cirrhotic Patient


Purpose of Review

To describe the main indications and contraindications of transjugular intrahepatic portosystemic shunt (TIPS) placement in patients with portal hypertension (PH).

Recent Findings

An adequate selection of patients helps to identify those who may benefit from TIPS in terms of survival. In patients with acute variceal bleeding and factors of poor prognosis, a pre-emptive use of TIPS is associated with significant reductions in treatment failure and mortality. Similarly, TIPS has shown to improve survival in a highly selected group of patients with cirrhosis and refractory ascites.


PH is a clinical syndrome associated with the appearance of certain complications which can lead to high morbidity and mortality. TIPS placement effectively reduces portal pressure improving the outcomes of patients who present severe and/or refractory complications of PH. However, an adequate selection of candidates seems to be a key factor for improving the outcomes of patients treated with TIPS.


Portal hypertension Transjugular intrahepatic portosystemic shunt TIPS Variceal bleeding Refractory ascites Portal vein thrombosis Cirrhosis Esophageal varices 


Financial Support

This work was sponsored by the Instituto de Salud Carlos III (ISCIII) PI14/00182 and PI17/00298 and the European Union (Fondos FEDER, “Una manera de hacer Europa”). CIBERehd is funded by Instituto de Salud Carlos III.

Compliance with Ethical Standards

Conflict of Interest

José Ferrusquía-Acosta reports personal fees from GORE, outside the submitted work.

Virginia Hernández-Gea reports personal fees from GORE, outside the submitted work.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • José Ferrusquía-Acosta
    • 1
  • Virginia Hernández-Gea
    • 1
    • 2
    Email author
  1. 1.Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic de Barcelona, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)University of BarcelonaBarcelonaSpain
  2. 2.Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)MadridSpain

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