1. TIPS creates a connection between the portal and systemic circulations using a minimally invasive technique (Fig. 45-3: Transjugular intrahepatic portal systemic shunt (TIPS) procedure).
2. The indications are to decompress portal hypertension in the setting of esophageal varices or intractable ascites.
3. Sedation is commonly used to facilitate placement, although some proceduralists prefer general anesthesia because it limits patient movement, controls diaphragmatic excursion, and reduces the risk of aspiration.
   1. Because of coagulopathy, patients may require clotting factors or platelets before the procedure.
   2. Complications include the possibility of hemorrhage, which can occur in the presence of extrahepatic hepatic artery or portal vein puncture.

The Liver: Surgery and Anesthesia

1. Assessment of Hepatic Function
2. Hepatobiliary Imaging
3. Liver Biopsy
4. Hepatic and Hepatobiliary Diseases
5. Acute Liver Failure
6. Acute Hepatitis
7. Alcoholic Hepatitis
8. Drug-Induced Liver Injury
9. Pregnancy-Related Liver Diseases
10. Cirrhosis and Portal Hypertension
11. Hemostasis
12. Cardiac Manifestations
13. Renal Dysfunction
14. Pulmonary Complications
15. Hepatic Encephalopathy (HE)
16. Ascites
17. Varices
18. Chronic Cholestatic Disease
19. Chronic Hepatocellular Disease
20. Hepatocellular Carcinoma (HCC)
21. Nonalcoholic Fatty Liver Disease
22. Preoperative Management
23. Intraoperative Management
24. Transjugular Intrahepatic Portosystemic Shunt Procedure
25. Hepatic Resection
26. Postoperative Liver Dysfunction