Surgical shunt versus TIPS for treatment of variceal hemorrhage in the current era of liver and multivisceral transplantation.

Over the last 3 decades, management of acute variceal bleeding and measures to prevent recurrent episodes has evolved due to the introduction of new therapeutic modalities including innovative surgical and minimally invasive shunt procedures. Such an evolution has been compounded by the parallel progress that has been achieved in organ transplantation. This article focuses primarily on the commonly used surgical and radiologic shunt procedures. Liver and multivisceral transplantation are also briefly discussed as important parts of the algorithmic management of these complex patients, particularly those with hepatic decompensation and portomesenteric venous thrombosis.