Transjugular intrahepatic portosystemic shunt (TIPS) is most urgently indicated in which clinical scenario?

• A Refractory ascites as first-line management before large-volume paracentesis
• B Hepatic encephalopathy in decompensated cirrhosis
• C Budd-Chiari syndrome presenting with acute hepatic failure
• D Acute variceal haemorrhage refractory to endoscopic band ligation and pharmacotherapy ✓

Explanation

TIPS is most urgently indicated for acute variceal haemorrhage (gastro-oesophageal varices) refractory to combined endoscopic therapy (band ligation/sclerotherapy) and pharmacotherapy (terlipressin/octreotide/beta-blockers). Early TIPS (within 72 hours) is now recommended for high-risk patients (Child-Pugh C or Child-Pugh B with active bleeding). TIPS creates an intrahepatic portacaval shunt via a covered stent-graft, decompressing portal hypertension and reducing variceal pressure. Refractory ascites is an elective indication after paracentesis fails. Hepatic encephalopathy is a complication and relative contraindication to TIPS (worsened by portosystemic shunting). Budd-Chiari may require TIPS but is less urgent.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.