Outline the mechanism of action and list the indications, contraindications and complications of the TIPSS procedure (Transjugular intrahepatic portosystemic shunt).
Mechanism of action:
Percutaneous formation of a tract between hepatic vein and intrahepatic segment of portal vein. Blood is shunted away from portal circulation to systemic circulation, thereby reducing portal pressure.
Indications: (20% Marks)
Contraindications (1 mark/point to max 4 points) (30% marks)
Complications: (50% marks)
Candidates responses lacked specific details.
In short, the rationale for a TIPS can be summarised as follows:
Indications for TIPS include:
Contraindications (from Boyer and Haskal, 2009) include
Technical complications of TIPS procedure:
Complications from portal venous shunt:
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