Der Transjuguläre Intrahepatische Portosystemische Shunt (TIPS): aktuelle und innovative Konzepte

Widmung

Dieser Artikel ist Herrn Prof. Dr. Martin Rössle zu seinem kommenden 80. Geburtstag gewidmet.

Zusammenfassung

Die Implantation eines transjugulären intrahepatischen portosystemischen Shunts (TIPS) hat sich als etabliertes interventionelles Verfahren zur Behandlung der dekompensierten Leberzirrhose und ihrer Komplikationen bewährt und wurde in den letzten Jahren kontinuierlich weiterentwickelt. Aktuelle Forschungsfragen konzentrieren sich darauf, die Patientenselektion und den Zeitpunkt der Intervention weiter zu optimieren. Eine TIPS-Anlage senkt effektiv den Druck in der Pfortader, wodurch die bakterielle Translokation und die systemische Entzündung bei Zirrhosepatienten gemindert werden. Diese Reduktion der Entzündung konnte mit einer Verringerung von Dekompensationsereignissen und einer Verbesserung der Überlebensraten in Verbindung gebracht werden. Dennoch bleiben Herausforderungen bei der präzisen Anpassung des portosystemischen Gradienten (PSG), um Symptome zu kontrollieren und Risiken wie hepatische Enzephalopathie oder kardiale Komplikationen zu minimieren. Die Hauptindikationen für TIPS umfassen Varizenblutungen (insbesondere bei Hochrisikopatienten mit präemptivem TIPS innerhalb von 72 Stunden), rezidivierendem Aszites und das Budd-Chiari-Syndrom. Eine strenge Patientenselektion ist entscheidend, um den Nutzen zu maximieren und Risiken zu minimieren. Zusammenfassend stellt die TIPS-Anlage einen effektiven Ansatz zur Behandlung von Komplikationen der Leberzirrhose dar, welcher das Überleben und die Lebensqualität der Patienten verbessert.

Abstract

Implantation of a transjugular intrahepatic portosystemic shunt (TIPS) has become an established interventional procedure for treating decompensated liver cirrhosis and its complications, such as portal hypertension. Current research focuses on optimizing patient selection and timing to enhance outcomes further. TIPS effectively reduces portal vein pressure, mitigating bacterial translocation and systemic inflammation associated with cirrhosis. This reduction in inflammation has been shown to decrease decompensation events and improve survival rates. However, challenges remain regarding the precise adjustment of the portosystemic gradient (PSG) to balance symptom control with minimizing risks such as hepatic encephalopathy or cardiac complications. The main indications for TIPS include variceal bleeding (especially high-risk patients requiring preemptive TIPS within 72 hours), recurrent ascites, and Budd-Chiari syndrome. Strict patient selection is crucial to maximize benefits while minimizing risks. Emerging evidence highlights the importance of addressing both portal hypertension and inflammation to improve clinical outcomes. In summary, TIPS represents an effective approach to managing complications of liver cirrhosis that improves survival and quality of life for affected patients.

Schlüsselwörter

Trasjugulärer intrahepatischer portosystemischer Shunt - Indikation - Leberzirrhose - Dekompensation - Inflammation

Keywords

transjugular intrahepatic portosystemic shunt - indication - cirrhosis - decompensation - inflammation

Publication History

Received: 04 June 2025

Accepted after revision: 12 September 2025

Article published online:
26 January 2026

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